In-hospital outcome in patients presenting with acute coronary syndrome with left main coronary artery disease: A report from Japanese prospective multicenter percutaneous coronary intervention registry
In-hospital outcome in patients presenting with acute coronary syndrome with left main coronary artery disease: A report from Japanese prospective multicenter percutaneous coronary intervention registry
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急性冠状动脉综合征合并左主干冠状动脉疾病患者的院内结局：来自日本前瞻性多中心经皮冠状动脉介入治疗登记处的报告
DOI：
10.1016/j.jjcc.2019.11.006
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发表时间：
2019
影响因子：
2.5
通讯作者：
Kohsaka Shun
中科院分区：
文献类型：
--
作者：
Tani Hidenori;Sawano Mitsuaki;Numasawa Yohei;Kobayashi Yuhei;Suzuki Masahiro;Noma Shigetaka;Shiraishi Yasuyuki;Ueda Ikuko;Fukuda Keiichi;Kohsaka Shun
背景：尽管经皮冠状动脉介入治疗（PCI）的设备和技术最近有所进步，但左主干（LM）疾病引起的急性冠脉综合征（ACS）患者的死亡率仍然很高。我们的目的是评估接受LM-PCI治疗的ACS患者的患者特征、临床表现和与不良住院结果相关的关键临床特征。方法回顾性地从2009年3月至2016年5月前瞻性多中心日本心血管数据库-庆应义塾医院间心血管研究登记处的7608例ACS患者中筛选出280例（3.7%），并将其分为行/不行PCI/冠状动脉旁路移植术组。我们比较了两组患者的基线人口统计学特征、冠状动脉病变特征、PCI细节和短期结果，包括住院死亡率和围手术期并发症。结果LM-ACS患者中38.6%表现为ST段抬高型心肌梗死，29.6%表现为心源性休克，15.4%表现为心脏骤停。观察到的住院死亡率为18.9%，存在CS[优势比（OR）： 10.16, 95%可信区间（CI）： 4.51-22.91,p< 0.001]，先前没有血运重建术（新生患者；OR: 4.31, 95% CI: 1.43-12.94,p= 0.009）是住院死亡率较高的独立相关因素。值得注意的是，观察到的新患者死亡率明显高于采用当代风险模型预测的死亡率（观察到的死亡率为25.1%，预测的死亡率为11.6%）。结论术前血运重建术是当代PCI时代LM-ACS患者的保护因素。需要进一步的研究来检测LM冠状动脉病变进展的高风险人群，以将这些发现充分应用于临床实践。
BackgroundPatients presenting with acute coronary syndrome (ACS) from left main (LM) disease are at a high risk for mortality despite recent advancement in devices and techniques during percutaneous coronary interventions (PCI). We aimed to evaluate patient characteristics, clinical presentations, and key clinical characteristics associated with adverse in-hospital outcomes among ACS patients undergoing LM-PCI.MethodsWe retrospectively identified 280 LM-ACS patients (3.7 %) from 7608 ACS patients in the prospective multicenter Japan Cardiovascular Database-Keio Inter-Hospital Cardiovascular Studies registry from March 2009 to May 2016 and divided them into those with/without PCI/coronary artery bypass grafting. We compared baseline demographics, coronary lesion characteristics, PCI details, and short-term outcomes, including in-hospital mortality and periprocedural complications, between the two groups.ResultsAmong LM-ACS patients, 38.6 % presented with ST elevation myocardial infarction, 29.6 % with cardiogenic shock (CS), and 15.4 % with cardiac arrest. The observed in-hospital mortality rate was 18.9 % with presence of CS [odds ratio (OR): 10.16, 95 % confidence interval (CI): 4.51–22.91,p< 0.001] and absence of prior revascularization (de novopatients; OR: 4.31, 95 % CI: 1.43–12.94,p= 0.009) was independently associated with higher incidence of in-hospital mortality. Notably, the observed mortality rate was substantially higher amongde novopatients than the predicted mortality rate with a contemporary risk model (observed: 25.1 %; predicted: 11.6 %).ConclusionsPrior revascularization act as a protective factor among LM-ACS patients in the contemporary era of PCI. Further studies to detect those at higher risk for LM coronary lesion progression are needed to fully implement these findings into clinical practice.