Yabe T, Takata J, Chikamori T, Seo H, Yamada M, Yamasaki F, Doi Y
Department of Medicine and Gerontology, Kochi Medical School.
J Cardiol. 1995 Nov;26(5):281-6.
Patients with myocardial infarction (MI) and triple vessel coronary disease generally have poor prognoses. However, it is not known whether there are particular angiographic variables associated with the poor prognosis in MI patients with triple vessel disease. The angiographic variables for poor prognosis were investigated in 43 MI patients with triple vessel disease (32 men and 11 women, mean age 63 +/- 9 years) who were followed medically for a mean of 32 +/- 28 months. There were 13 cardiac deaths (30%) and 10 late-coronary artery bypass grafting (23%). Twenty patients were alive and well. The patients who died of cardiac causes had lower ejection fractions (42 +/- 18% vs 49 +/- 15%, p < 0.05), a higher prevalence of two vessel occlusion (77% vs 40%, p < 0.05), and a higher prevalence of coronary occlusion opposite the MI site (69% vs 25%, p < 0.01) when compared to survivors, although there were no significant differences in age, MI sites, or the prevalence of occlusion in the infarct-related artery. Multivariate analysis with the Cox proportional hazards model revealed that coronary occlusion opposite the MI site (hazards ratio 16.36) and an age of > or = 65 years (4.46) indicated a significantly high ratio. The hazard ratio of the ejection fraction and two vessel coronary occlusion were not significant. The poor prognosis of MI patients with triple vessel coronary disease may be related to impaired left ventricular function and to coronary occlusion opposite the MI site and greater age. This may have important clinical implications in the initial decision for interventional therapy.
患有心肌梗死（MI）和三支血管冠状动脉疾病的患者通常预后较差。然而，尚不清楚在患有三支血管疾病的MI患者中，是否存在与预后不良相关的特定血管造影变量。对43例患有三支血管疾病的MI患者（32例男性和11例女性，平均年龄63±9岁）进行了研究，这些患者接受了平均32±28个月的医学随访，以调查预后不良的血管造影变量。共有13例心源性死亡（30%）和10例晚期冠状动脉搭桥手术（23%）。20例患者存活且状况良好。与幸存者相比，心源性死亡患者的射血分数较低（42±18%对49±15%，p<0.05），双支血管闭塞的患病率较高（77%对40%，p<0.05），以及MI部位对侧冠状动脉闭塞的患病率较高（69%对25%，p<0.01），尽管在年龄、MI部位或梗死相关动脉闭塞的患病率方面没有显著差异。使用Cox比例风险模型进行多变量分析显示，MI部位对侧冠状动脉闭塞（风险比16.36）和年龄≥65岁（4.46）表明风险比显著较高。射血分数和双支血管冠状动脉闭塞的风险比不显著。患有三支血管冠状动脉疾病的MI患者预后不良可能与左心室功能受损、MI部位对侧冠状动脉闭塞以及年龄较大有关。这可能对介入治疗的初始决策具有重要的临床意义。
