Impact of coronary dominance on in-hospital outcomes after percutaneous coronary intervention in patients with acute coronary syndrome.
Impact of coronary dominance on in-hospital outcomes after percutaneous coronary intervention in patients with acute coronary syndrome.
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DOI：
10.1371/journal.pone.0072672
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Fukuda K
中科院分区：
文献类型：
--
作者：
Kuno T;Numasawa Y;Miyata H;Takahashi T;Sueyoshi K;Ohki T;Negishi K;Kawamura A;Kohsaka S;Fukuda K
这项研究评估了冠状动脉优势对接受经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者的住院结果的影响。先前的研究表明，冠状动脉左主干解剖结构与冠状动脉疾病患者的预后较差有关。对2008年9月至2013年4月期间参加日本心血管数据库注册的14家医院的4873名接受冠状动脉介入治疗的ACS患者的数据进行了分析。根据冠状动脉介入治疗前的冠状动脉造影结果，将患者分为右显性或共显性解剖(RD组)和左显性解剖(LD组)。患者的平均年龄为67.6±11.8岁，两组患者的年龄、冠状动脉危险因素、合并症和既往病史相似。出现心力衰竭、心源性休克或心肺骤停症状的LD组显著高于RD组(心力衰竭：RD组650例(14.7%)对LD组87例(18.8%)，P = 0.025；心源性休克：RD组322例(7.3%)对LD组48例(10.3%)，P = 0.021；心肺骤停：RD组197例(4.5%)对LD组36例(7.8%)，P = 0.003)。LD患者的住院死亡率显著高于RD患者(182RD患者[4.1%]对36 LD患者[7.8%]，P = 0.001)。多因素Logistic回归分析显示，腰椎解剖结构是住院死亡率的独立预测因素(优势比1.75；95%可信区间1.0 6~2.89；P = 0.030)。在接受经皮冠状动脉介入治疗的ACS患者中，与RD患者相比，LD患者的住院结果明显更差，而LD解剖结构是住院死亡率的独立预测因素。
This study evaluated the manner in which coronary dominance affects in-hospital outcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Previous studies have shown that left dominant coronary anatomies are associated with worse prognoses in patients with coronary artery disease. Data were analyzed from 4873 ACS patients undergoing PCI between September 2008 and April 2013 at 14 hospitals participating in the Japanese Cardiovascular Database Registry. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right- or co-dominant anatomy (RD group) and those with left-dominant anatomy (LD group). The average patient age was 67.6±11.8 years and both patient groups had similar ages, coronary risk factors, comorbidities, and prior histories. The numbers of patients presenting with symptoms of heart failure, cardiogenic shock, or cardiopulmonary arrest were significantly higher in the LD group than in the RD group (heart failure: 650 RD patients [14.7%] vs. 87 LD patients [18.8%], P = 0.025; cardiogenic shock: 322 RD patients [7.3%] vs. 48 LD patients [10.3%], P = 0.021; and cardiopulmonary arrest: 197 RD patients [4.5%] vs. 36 LD patients [7.8%], P = 0.003). In-hospital mortality was significantly higher among LD patients than among RD patients (182 RD patients [4.1%] vs. 36 LD patients [7.8%], P = 0.001). Multivariate logistic regression analysis revealed that LD anatomy was an independent predictor for in-hospital mortality (odds ratio, 1.75; 95% confidence interval, 1.06–2.89; P = 0.030). Among ACS patients who underwent PCI, LD patients had significantly worse in-hospital outcomes compared with RD patients, and LD anatomy was an independent predictor of in-hospital mortality.
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