慢性完全闭塞病变对接受急诊介入治疗的急性心肌梗死患者远期预后的影响

目的:分析慢性完全闭塞(CTO)病变对接受急诊介入治疗的急性心肌梗死(AMI)患者远期预后的影响。方法:分析自2013年1月至2014年9月间纳入中国急性心肌梗死(CAMI)注册登记研究的接受急诊介入治疗的14176例AMI患者,根据冠状动脉造影的结果,将患者分为AMI合并CTO病变组(n=1235)和AMI不合并CTO病变组(n=12941)。随访2年,比较两组的临床预后,主要研究终点为死亡率,次要研究终点为包括心原性死亡、脑卒中、心力衰竭再入院、再次血运重建等的主要不良心血管事件。结果:合并CTO病变的AMI患者占8.7%(1235/14176)。随访2年,AMI合并CTO病变组的患者全因死亡率(9.9%vs.5.4%)和心原性死亡率(5.0%vs.2.6%)明显高于AMI不合并CTO病变组患者(P均<0.01)。单因素分析显示,CTO病变增加AMI患者死亡(HR=1.44,95%CI:1.02~2.03,P=0.04)和再次血运重建(HR=2.14,95%CI:1.55~2.96,P<0.01)风险。多因素回归分析显示,高龄(HR=1.07,95%CI:1.05~1.09)和就诊时存在心力衰竭(HR=2.05,95%CI:1.36~3.09)与患者2年死亡的不良预后明显相关(P均<0.01),而CTO病变不是2年死亡的独立危险因素(HR=1.33,95%CI:0.93~1.90,P=0.11)。结论:合并CTO病变的AMI患者的远期死亡率和心原性死亡率明显高于不合并CTO病变的患者。高龄和就诊时存在心力衰竭是远期死亡的独立危险因素,而CTO病变并不是远期死亡的独立危险因素。

Impact of Chronic Total Occlusion on Long-term Prognosis of Patients With Acute Myocardial Infarction Undergoing Primary Coronary Artery Intervention

Objectives:To evaluate the prognostic impact of chronic total occlusion(CTO)in patients with acute myocardial infarction undergoing primary coronary artery intervention(PCI).Methods:This observational study enrolled acute myocardial infarction(AMI)patients undergoing primary PCI from January 2013 to September 2014,the data were derived from China Acute Myocardial Infarction(CAMI)Registry.Patients were divided into CTO and non-CTO groups according to the results of coronary angiography.The patients were followed up for 2 years.The primary endpoint was all-cause mortality and cardiac death.The secondary endpoint was major adverse cardiovascular events including cardiac death,stroke,heart failure readmission,and repeat revascularization.Results:A total of 14176 AMI patients were included,prevalence of CTO was 8.7%in this patient cohort.During the 2 years follow-up,the mortality and cardiac death rate were significantly higher in CTO group compared with non-CTO group(9.9%vs.5.4%,P<0.01;5.0%vs.2.6%,P<0.01 respectively).Univariate analysis showed that CTO was correlated with increased risk of all-cause mortality(HR=1.44,95%CI:1.02~2.03,P=0.04)and repeat revascularization(HR=2.14,95%CI:1.55-2.96,P<0.01).Multiple regression analysis showed that advanced age(HR=1.07,95%CI:1.05-1.09,P<0.01)and symptomatic heart failure before procedure(HR=2.05,95%CI:1.36-3.09,P<0.01)were independent risk factors of death at 2 years follow up.CTO was not associated with 2-years death among AMI patients(HR=1.33,95%CI:0.93-1.90,P=0.11).Conclusions:CTO is associated with higher rate of all-cause mortality and cardiac death compared with non-CTO among AMI patients at 2 years follow-up.Advanced age and symptomatic heart failure before procedure are independent predictors of all-cause mortality at 2 years follow-up.However,CTO is not an independent predictor of all-cause death at 2 years follow-up in this patient cohort.