CAJ | 학술논문

目的分析无保护左主干(ULMCA)病变导致急性心肌梗死(AMI)合并心源性休克(CS)患者的临床表现和近、远期预后.方法从1999年1月至2014年5月,共完成5 798例急诊冠状动脉造影,入选经急诊造影证实梗死相关血管(IRA)为ULMCA的AMI患者.根据住院期间是否存在CS将患者分为休克组和对照组,收集入选患者的临床资料、造影及介入治疗资料.比较两组患者的临床情况和近、远期临床随访结果.分析ULMCA病变导致AMI患者合并CS的临床特点,以及合并CS对该类患者近、远期临床预后的影响.结果最终有58例ULMCA病变所致AMI患者纳入研究,其中31例患者(53.4％)存在CS.与对照组比较,CS组患者术前侧支循环2～3级的比率、最终的TIMI血流3级比率和左室射血分数较低.Logistic回归分析则提示仅有较低的术前侧支循环2-3级是住院期间发生CS的预测因素(OR =0.19,P=0.02).住院期间一共死亡23例(39.7％),其中休克组住院病死率明显高于对照组(64.5％ vs.11.1％,P＜0.01).Logistic回归分析提示CS是住院期间死亡的预测因素(OR =6.94,P=0.01).35例患者存活出院,完成中位数42.0个月(12.0,60.0)的随访.Kaplan-Meier分析估算无休克患者的总累计生存率为51.8％,而休克患者的总累计生存率仅为20.3％(Log-rank,P＜0.01).COX多因素回归分析显示,住院期间存在CS则是ULMCA病变所致AMI患者总病死率的唯一预测因素(HR =4.67,P=0.004).结论 ULMCA病变所致的AMI患者病情凶险,CS发生率高,CS与该类患者近、远期病死率相关.
목적 분석무보호좌주간(ULMCA)병변도치급성심기경사(AMI)합병심원성휴극(CS)환자적림상표현화근、원기예후.방법 종1999년1월지2014년5월,공완성5 798례급진관상동맥조영,입선경급진조영증실경사상관혈관(IRA)위ULMCA적AMI환자.근거주원기간시부존재CS장환자분위휴극조화대조조,수집입선환자적림상자료、조영급개입치료자료.비교량조환자적림상정황화근、원기림상수방결과.분석ULMCA병변도치AMI환자합병CS적림상특점,이급합병CS대해류환자근、원기림상예후적영향.결과 최종유58례ULMCA병변소치AMI환자납입연구,기중31례환자(53.4％)존재CS.여대조조비교,CS조환자술전측지순배2～3급적비솔、최종적TIMI혈류3급비솔화좌실사혈분수교저.Logistic회귀분석칙제시부유교저적술전측지순배2-3급시주원기간발생CS적예측인소(OR =0.19,P=0.02).주원기간일공사망23례(39.7％),기중휴극조주원병사솔명현고우대조조(64.5％ vs.11.1％,P＜0.01).Logistic회귀분석제시CS시주원기간사망적예측인소(OR =6.94,P=0.01).35례환자존활출원,완성중위수42.0개월(12.0,60.0)적수방.Kaplan-Meier분석고산무휴극환자적총루계생존솔위51.8％,이휴극환자적총루계생존솔부위20.3％(Log-rank,P＜0.01).COX다인소회귀분석현시,주원기간존재CS칙시ULMCA병변소치AMI환자총병사솔적유일예측인소(HR =4.67,P=0.004).결론 ULMCA병변소치적AMI환자병정흉험,CS발생솔고,CS여해류환자근、원기병사솔상관.
Objective To analyze the clinical characteristics and prognosis of the patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) due to unprotected left-main coronary artery (ULMCA) disease.Methods From January 1999 to May 2014,5 798 emergency coronary angiographies were performed.The AMI patients with infarction of related artery of ULMCA conformed by angiography were enrolled.Clinical characteristics and prognosis of the patients were studied.The patients were divided into two groups according to the occurrence of CS during hospitalization.The interventional data and outcome during short term and long term followed up were compared between the two groups.The causes of CS and mortality were analyzed.Results Fifty-eight patients were enrolled,and CS occurred in 31 patients (53.4％).Compared with CS free group,left ventricular ejection fraction,occurrence of TIMI grade 2-3 during diagnostic angiography,collateral circulation with Rentrop grade 2-3 and final flow of TIMI grade 3 were lower in the group with CS.Logistic analysis revealed poor collateral circulation (less than Rentrop grade 2) was related with occurrence of CS (OR =0.19,P =0.02).Twenty-three patients died in hospital,and the mortality in CS group was higher than that in the group without CS (64.5％ vs.11.1％,P ＜0.01).CS was confirmed as a powerful predictor of in-hospital mortality by Logistic analysis (OR =6.94,P =0.01).Long term follow up was performed in the 35 survivors with the duration of median time of 42.0 (12.0,60.0) months.The accumulative total survival rate was 20.3％ in patients with CS and 51.8％ in patients without CS (Log-rank,P ＜ 0.01).Multivariable COX regression analysis revealed the only independent predictor of total mortality during long-term follow up was CS during hospitalization (HR =4.67,P =0.004) . Conclusions AMI due to ULMCA disease was critically risky with high incidence of CS.The short term and long term prognosis of these patients with AMI caused by ULMCA disease complicated with CS was poor.