The impact of multivessel disease with and without a co-existing chronic total occlusion on short- and long-term mortality in ST-elevation myocardial infarction patients with and without cardiogenic shock
The impact of multivessel disease with and without a co-existing chronic total occlusion on short- and long-term mortality in ST-elevation myocardial infarction patients with and without cardiogenic shock
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DOI：
10.1093/eurjhf/hfs182
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发表时间：
2013-04-01
影响因子：
18.2
通讯作者：
Henriques, Jose P. S.
中科院分区：
文献类型：
--
作者：
Hoebers, Loes P.;Vis, Marije M.;Henriques, Jose P. S.
为评价伴或不伴慢性完全闭塞（CTO）的多支血管病变（MVD）对伴或不伴心源性休克（CS）的ST段抬高型心肌梗死（STEMI）患者早期和晚期死亡率的影响，共5018例STEMI患者接受了直接经皮冠状动脉介入治疗，并根据CS的存在和冠状动脉病变的程度分为单支血管病变（SVD）、无CTO的MVD和有CTO的MVD。我们进行了长达5年随访的标志性死亡率分析，并将标志性死亡率设定为30天。在无CS的患者中（n 4409），只有CTO的MVD是30天[风险比（HR）2.8，P 0.01]和5年死亡率（HR 1.7，P 0.01）的独立预测因子，而无CTO的MVD与死亡率增加无关。在CS患者（n 609）中，有和无CTO的MVD是30天死亡率的独立预测因素（HR 2.2，P 0.01和HR 1.8，P 0.01）。在30天CS存活者中，仅MVD伴CTO与死亡率增加趋势相关（HR 1.7，P 0.06）。在非CS STEMI伴MVD患者中，非梗死相关动脉中共存CTO导致早期和晚期死亡。在CS患者中，有或无CTO的MVD是短期死亡率的预测因子。
To evaluate the impact of multivessel disease (MVD) with and without a chronic total occlusion (CTO) on early and late mortality in ST-elevation myocardial infarction (STEMI) patients with and without cardiogenic shock (CS).A total of 5018 STEMI patients were treated with primary percutaneous coronary intervention and stratified according to the presence of CS and the extent of coronary artery disease into single vessel disease (SVD), MVD without a CTO, and MVD with a CTO. We performed a landmark mortality analysis up to 5-year follow-up with a landmark set at 30 days. In patients without CS (n 4409), only MVD with a CTO was an independent predictor for 30-day [hazard ratio (HR) 2.8, P 0.01] and 5-year mortality (HR 1.7, P 0.01), whereas MVD without a CTO was not associated with increased mortality. In CS patients (n 609), MVD with and without a CTO were independent predictors for 30-day mortality (HR 2.2, P 0.01 and HR 1.8, P 0.01). In 30-day CS survivors, only MVD with a CTO was associated with a trend towards increased mortality (HR 1.7, P 0.06).In non-CS STEMI patients with MVD, the presence of a co-existing CTO in a non-infarct-related artery drives early and late mortality. In patients with CS, MVD with and without a CTO were predictors for short-term mortality.