Coronary dominance and prognosis of patients with acute coronary syndrome
Coronary dominance and prognosis of patients with acute coronary syndrome
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DOI：
10.1016/j.ahj.2007.07.041
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发表时间：
2007-12-01
影响因子：
4.8
通讯作者：
Ghali, William A.
中科院分区：
文献类型：
--
作者：
Goldberg, Alexander;Southern, Danielle A.;Ghali, William A.
许多研究已经确定病变血管的数量是急性冠脉综合征（ACS）患者生存的重要决定因素。目前尚不清楚冠状动脉优势是否对这些患者的预后有影响。我们假设左显性ACS患者的预后比右显性或混合显性ACS患者差。方法选取27289例心导管主要指征为ACS的患者作为研究对象。根据冠脉优势度将患者分为3组。平均随访时间为3.5年（1-6.5年）。Cox比例风险分析用于比较优势生存率，调整年龄、性别、诊断、合并症、冠状动脉疾病严重程度和射血分数。两组显著冠心病患者的血运重建率和模式相似。随访结束时，LID患者的死亡率明显高于对照组（风险比1.18,95% Cl 1.05-1.34；校正风险比1.13,Cl 1.00-1.28）。混合型和右优势型患者的死亡率相似。结论：在ACS患者中，LID是长期死亡率增加的重要且独立的预测因子。需要进一步的研究来确定LID患者死亡率增加的机制，以及可以采取的措施来改善左优势循环患者的预后。
Background A number of studies have identified the number of diseased vessels to be an important determinant of survival in patients with acute coronary syndrome (ACS). It is unknown if coronary dominance has an impact on prognosis of these patients. We hypothesized that the prognosis of patients with ACS with left dominance (LD) would be worse than that of patients with right or mixed dominance.Methods The study population consisted of 27289 patients whose primary indication for cardiac catheterization was ACS. The patients were divided into 3 groups according to coronary dominance. The mean duration of follow-up was 3.5 years (range 1-6.5 years). A Cox proportional hazards analysis was used to compare survival by dominance, adjusting for age, sex, diagnosis, comorbidities, severity of coronary disease, and ejection fraction.Results. The rates and patterns of revascularization among patients with significant coronary disease were similar between the groups. At the end of follow-up, patients with LID had a significantly higher mortality (hazard ratio 1.18, 95% Cl 1.05-1.34; adjusted hazard ratio 1.13, Cl 1.00-1.28). The mortality of patients with mixed and right dominance was similar.Conclusion In patients with ACS, LID is a significant and independent predictor of increased long-term mortality. Further research is needed to determine mechanisms of increased mortality in patients with LID and measures that can be taken to improve the outcome of patients with left-dominant circulation.