Rapid predictors for the occurrence of reduced left ventricular ejection fraction between LAD and non-LAD related ST-elevation myocardial infarction
Rapid predictors for the occurrence of reduced left ventricular ejection fraction between LAD and non-LAD related ST-elevation myocardial infarction
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LAD 和非 LAD 相关 ST 段抬高型心肌梗死之间左心室射血分数降低发生的快速预测因素
DOI：
10.1186/s12872-015-0178-y
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发表时间：
2016-01-05
影响因子：
2.1
通讯作者：
Ge, Jun-Bo
中科院分区：
文献类型：
--
作者：
Chen, Zhang-Wei;Yu, Zi-Qing;Ge, Jun-Bo
急性心肌梗死（AMI）后左室射血分数（LVEF）降低，提示心功能不全的发生，影响心脏预后，即使在直接经皮冠状动脉介入治疗（PCI）后也是如此。本研究旨在阐明左前降支（LAD）或非LAD血管作为罪犯artery.MethodsThis是一项回顾性研究，共553例ST段抬高型心肌梗死（STEMI）患者行直接PCI的临床和血管造影预测LVEF降低的差异。所有患者均接受超声心动图检查。采用单因素分析、多因素分析和分类回归树（CART）分析左前降支相关性AMI与非左前降支相关性ST段抬高型心肌梗死的相关性。结果STEMI的罪犯动脉中，LAD系统315支（左主干6支，LAD 309支），非LAD系统238支（左回旋支63支，右冠状动脉175支）。与非LAD组相比，LAD相关STEMI组MI后LVEF显著降低（52.4 ± 9.3%vs.57.1 ± 7.8%，P < 0.01）。多因素分析显示，年龄（>65岁）、入院时间和近端闭塞与LAD相关STEMI患者的LVEF降低（<55%）相关。然而，在非LAD患者中，到医院的时间、多支血管狭窄和PCI术后血压可预测LVEF降低的发生。此外，CART分析也获得了类似的结果。结论与LAD或非LAD相关的STEMI患者可以遭受降低LVEF，而临床和血管造影预测的发生是不同的。
BackgroundsReduced left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI), which implies the occurrence of cardiac dysfunction, impacts cardiac prognosis, even after primary percutaneous coronary intervention (PCI). This study was designed to clarify the difference of clinical and angiographic predictors for reduced LVEF in ST-elevation myocardial infarction (STEMI) patients with left anterior descending artery (LAD) or non-LAD vessel as culprit artery.MethodsThis was a retrospective study to review a total of 553 patients of STEMI underwent primary PCI in our hospital. All patients underwent echocardiography. Univariate analysis, multivariate analysis and classification and regression tree (CART) were performed between LAD related AMI and non-LAD related STEMI. The primary outcome was the occurrence of reduced LVEF 4–6 days after PCI.ResultsIn this study, culprit arteries of STEMI were 315 in LAD system (6 in left main artery, 309 in LAD) and 238 in non-LAD system (63 in left circumflex and 175 in right coronary artery). Compared with non-LAD group, post-MI LVEF was significantly reduced in LAD related STEMI group (52.4 ± 9.3 % vs. 57.1 ± 7.8 %,P< 0.01). Multivariate analysis indicated that elder (>65 years), time to hospital and proximal occlusion were associated with reduced LVEF (<55 %) in LAD related STEMI patients. However, in non-LAD patients, time to hospital, multivessel stenosis and post-PCI blood pressure predicted the occurrence of reduced LVEF. Furthermore, CART analysis also obtained similar findings.ConclusionsPatients with LAD or non-LAD related STEMI could suffer reduced LVEF, while the clinical and angiographic predictors for the occurrence were different.