Moreno R, García E, Elízaga J, Abeytua M, Soriano J, Botas J, López-Sendón J L, Delcán J L
Departamento de Cardiología, Hospital Gregorio Marañón, Madrid.
Rev Esp Cardiol. 1998 Jul;51(7):547-55. doi: 10.1016/s0300-8932(98)74788-8.
In patients with acute myocardial infarction treated with primary angioplasty, multivessel disease is associated with a higher mortality. However, if higher mortality is simply due to a higher prevalence of cardiogenic shock or if multivessel disease is an independent risk factor remains unclear.
To study if multivessel disease constitute an independent prognostic factor in patients with acute myocardial infarction treated with primary angioplasty, and to ascertain possible mechanisms contributing to the worse prognosis found in these patients.
Between august 1991 and october 1996, 312 patients with acute myocardial infarction were treated with primary angioplasty in our center. Characteristics and in-hospital outcome of patients with or without multivessel disease were compared.
Patients with multivessel disease (n = 158; 51%) were older (64 +/- 11 vs 61 +/- 13 years; p = 0.017), less often smokers (60% vs. 76%; p = 0.006) and had a higher prevalence of diabetes (35% vs. 20%; p = 0.007), hypertension (54% vs. 39%; p = 0.012), prior acute myocardial infarction (29% vs. 5%; p < 0.001), prior coronary bypass (2% vs. 0%; p = 0.042) and Killip class IV at admission (19% vs. 8%; p < 0.001). Angiographic success rate was not different in patients with or without multivessel disease (89% vs. 92%; NS). Patients with multivessel disease had a higher in-hospital mortality (21% vs. 7%; p < 0.001), need of revascularization (17% vs. 3%; p < 0.001) and incidence of severe mitral regurgitation, (5% vs. 0%; p < 0.001), second or third atrioventricular blockade (10% vs. 1%; p < 0.001) and severe bleeding (4% vs. 1%; p = 0.089). After excluding patients with Killip class III or IV at admission, mortality was also higher in patients with multivessel disease (9% vs. 2%; p = 0.009). Multivariate analysis showed the following independent risk factors for mortality: age > 65 years, Killip class IV and multivessel disease.
In patients with acute myocardial infarction treated with primary angioplasty, multivessel disease is associated with higher mortality. This is due not only to a higher prevalence of cardiogenic shock at admission, but also to a worse baseline profile, a higher incidence of complications and a more frequent need of revascularization.
在接受直接血管成形术治疗的急性心肌梗死患者中，多支血管病变与较高的死亡率相关。然而，较高的死亡率是单纯由于心源性休克的患病率较高，还是多支血管病变是一个独立的危险因素，目前尚不清楚。
研究多支血管病变是否构成接受直接血管成形术治疗的急性心肌梗死患者的独立预后因素，并确定导致这些患者预后较差的可能机制。
1991年8月至1996年10月期间，我们中心对312例急性心肌梗死患者进行了直接血管成形术治疗。比较了有或无多支血管病变患者的特征和住院结局。
有多支血管病变的患者（n = 158；51%）年龄较大（64±11岁对61±13岁；p = 0.017），吸烟者较少（60%对76%；p = 0.006），糖尿病患病率较高（35%对20%；p = 0.007），高血压患病率较高（54%对39%；p = 0.012），既往有急性心肌梗死病史（29%对5%；p < 0.001），既往有冠状动脉搭桥手术史（2%对0%；p = 0.042），入院时Killip分级为IV级（19%对8%；p < 0.001）。有或无多支血管病变患者的血管造影成功率无差异（89%对92%；无显著性差异）。有多支血管病变的患者住院死亡率较高（21%对7%；p < 0.001），需要进行血管重建的比例较高（17%对3%；p < 0.001），严重二尖瓣反流的发生率较高（5%对0%；p < 0.001），二度或三度房室传导阻滞的发生率较高（10%对1%；p < 0.001），严重出血的发生率较高（4%对1%；p = 0.089）。排除入院时Killip分级为III级或IV级的患者后，有多支血管病变的患者死亡率也较高（9%对2%；p = 0.009）。多因素分析显示以下死亡率的独立危险因素：年龄>65岁、Killip分级为IV级和多支血管病变。
在接受直接血管成形术治疗的急性心肌梗死患者中，多支血管病变与较高的死亡率相关。这不仅是由于入院时心源性休克的患病率较高，还由于基线情况较差、并发症发生率较高以及血管重建的需求更频繁。
