Angiographic and Clinical Characteristics of Type 1 Versus Type 2 Perioperative Myocardial Infarction
Angiographic and Clinical Characteristics of Type 1 Versus Type 2 Perioperative Myocardial Infarction
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DOI：
10.1002/ccd.24626
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发表时间：
2013-10-01
影响因子：
2.3
通讯作者：
Goldstein, James
中科院分区：
文献类型：
--
作者：
Hanson, Ivan;Kahn, Joel;Goldstein, James
目的分析围手术期心肌梗死（PMI）两种病因亚型的临床和血管造影差异。背景PMI被认为是由于急性斑块破裂和血栓形成导致冠状动脉血流量减少（1型）或稳定但狭窄病变的原发性需氧量增加（2型）而发生的。PMI的发病率和死亡率是相当大的，但血管造影和临床特征没有很好地characterized. MethodsConcretive与PMI患者被归类为1型或2型罪犯病变的血管造影特征的基础上。每个亚型的临床和血管造影特征进行了比较，使用statistical analysis.ResultsOf 54例分析，32（59%）例1型PMI，而22人（41%）有2型PMI。与2型患者相比，1型PMI患者更常进行ECG检查，（心电图）ST段抬高（53% vs 23%，P = 0.026），肌钙蛋白峰值更高（15.3 ng/dl vs 5.3 ng/dl，P = 0.035），术前平均血压较高（103 mm Hg vs 93 mm Hg，P = 0.009），平均术中血压下降幅度更大（-36 mm Hg vs-26 mm Hg，P = 0.015）。I型患者倾向于更大的住院死亡率（16%对5%，P = 0.38）和住院时间（13.5天对9.0天，P = 0.13）。结论这些结果表明，PMI不仅是由于需求缺血，但也在近60%的情况下，原因是急性斑块破裂。由于斑块破裂导致的PMI患者术中低血压、透壁性缺血、梗死面积更大，预后更差。(c)2012 Wiley Periodicals，Inc.
ObjectivesThe aim of this study was to analyze clinical and angiographic differences between the two etiologic subtypes of perioperative myocardial infarction (PMI).BackgroundPMI is believed to occur by either reduced coronary blood flow attributable to acute plaque rupture and thrombosis (type 1) or primary increase in oxygen demand in the setting of stable but stenotic lesions (type 2). Incidence and mortality rates of PMI are substantial, but angiographic and clinical features are not well characterized.MethodsConsecutive patients with PMI were classified as type 1 or type 2 based on angiographic characteristics of culprit lesions. Clinical and angiographic characteristics of each subtype were compared using statistical analyses.ResultsOf the 54 patients analyzed, 32 (59%) cases had type 1 PMI, whereas 22 others (41%) had type 2 PMI. Compared with type 2 patients, those with type 1 PMI more often had ECG (electrocardiogram) ST elevation (53% versus 23%, P = 0.026), greater peak troponin (15.3 ng/dl versus 5.3 ng/dl, P = 0.035), higher preoperative mean blood pressure (103 mm Hg versus 93 mm Hg, P = 0.009), greater decrease in mean intraoperative blood pressure (-36 mm Hg versus -26 mm Hg, P = 0.015). Type I patients trended toward greater in-hospital mortality (16% versus 5%, P = 0.38) and length of hospitalization (13.5 days versus 9.0 days, P = 0.13).ConclusionsThese results demonstrate that PMI not only results from demand ischemia but also that in nearly 60% of cases the cause is acute plaque rupture. Patients with PMI attributable to plaque rupture suffer more intraoperative hypotension, greater transmural ischemia, larger infarct size, and trended toward worse outcome. (c) 2012 Wiley Periodicals, Inc.