摘要
目的评估慢性闭塞病变(CTO)对接受急诊经皮冠状动脉介入治疗(PCI)的急性非ST段抬高型心肌梗死(NSTEMI)患者近远期预后的影响。方法研究纳入中国急性心肌梗死患者前瞻性注册研究中接受急诊PCI的2271例急性NSTEMI患者,根据造影结果分为合并CTO组和非合并CTO组,主要研究终点为在院期间和术后2年病死率,次要研究终点为2年时的总心血管不良事件率,包括再次血运重建、死亡、再发心肌梗死、心力衰竭再入院、卒中、严重出血等。结果急性NSTEMI患者中有13.4%合并CTO,与非合并CTO患者相比,在院期间病死率(3.6%比1.4%,P<0.01)和2年随访病死率(9.0%比5.1%,P<0.01)明显增加。多因素回归分析提示慢性阻塞性肺疾病是接受急诊PCI患者住院期间死亡的独立危险因素(HR 7.28,95%CI 1.50~35.35,P=0.01),而高龄(HR 1.04,95%CI 1.01~1.07,P<0.01)和射血分数(EF)减低(HR 0.95,95%CI 0.93~0.98,P<0.01)是远期死亡的独立危险因素。CTO并未增加患者死亡风险,而是再次血运重建的独立危险因素(HR 1.67,95%CI 1.10~2.54,P=0.02)。结论尽管合并CTO的急性NSTEMI患者近远期病死率明显增加,但CTO并不是急性NSTEMI患者近远期死亡的独立危险因素,仅和再次血运重建增加相关,高龄和EF减低是接受急诊PCI的急性NSTEMI患者2年死亡的独立危险因素。
Objectives To investigate the clinical impacts of chronic total occlusion(CTO)in acute non-ST segment elevation myocardial infarction(NSTEMI)patients underwent primary percutaneous coronary intervention(PCI).Methods A total of 2271 acute NSTEMI patients underwent primary PCI from China Acute Myocardial Infarction Registry were enrolled in this study and divided into the CTO group and the non-CTO group according to the angiography.The primary endpoint was in-hospital mortality and mortality during a 2-year follow-up.The secondary endpoint was major adverse cardiovascular events(MACE)including revascularization,death,re-myocardial infarction,heart failure readmission,stroke and major bleeding.Results Thirteen-point four percent of the total acute NSTEMI patients had concurrent CTO.In-hospital mortality(3.6%vs.1.4%,P<0.01)and 2-year mortality(9.0%vs.5.1%,P<0.01)were significantly higher in the CTO group than those in the non-CTO group,respectively.Multiple regression analyses showed that chronic obstructive pulmonary disease(HR 7.28,95%CI 1.50-35.35,P=0.01)was an independent risk factor of in-hospital mortality,and advanced age(HR 1.04,95%CI 1.01-1.07,P<0.01),and low levels of ejection fraction(HR 0.95,95%CI 0.93-0.98,P<0.01)were independent risk factors of 2-year mortality.CTO(HR1.67,95%CI 1.10-2.54,P=0.02)was an independent risk factor of revascularization,but not a risk factor of mortality.Conclusions Although acute NSTEMI patients concurrent with CTO had higher mortality,CTO was only an independent risk factor of revascularization,but not of mortality.Advanced age and low levels of ejection fraction were independent risk factors of long-term death among acute NSTEMI patients.
作者
王天杰
董军乐
闫森
陈桂浩
陈舸
赵延延
钱海燕
袁建松
宋雷
乔树宾
杨进刚
杨伟宪
杨跃进
中国急性心肌梗死注册登记研究组
Wang Tianjie;Dong Junle;Yan Sen;Chen Guihao;Chen Ge;Zhao Yanyan;Qian Haiyan;Yuan Jiansong;Song Lei;Qiao Shubin;Yang Jingang;Yang Weixian;Yang Yuejin;China Acute Myocardial Infarction(CAMI)Registry Research Group(Coronary Heart Disease Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China;Medical Research and Biometrics Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China;不详)
出处
《中华内科杂志》
CAS
CSCD
北大核心
2022年第4期384-389,共6页
Chinese Journal of Internal Medicine
基金
国家“十二五”科技支撑计划课题(2011BAI11B02)。
关键词
心肌梗死
急性
心肌血管重建术
慢性闭塞病变
预后
Myocardial infarction
Acute
Myocardial revascularization
Chronic total occlusion
Prognosis
