Comparison of outcome in patients with ST-elevation versus non-ST-elevation acute myocardial infarction treated with percutaneous coronary intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry)
Comparison of outcome in patients with ST-elevation versus non-ST-elevation acute myocardial infarction treated with percutaneous coronary intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry)
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DOI：
10.1016/j.amjcard.2007.02.083
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发表时间：
2007-07-15
影响因子：
2.8
通讯作者：
Williams, David O.
中科院分区：
文献类型：
--
作者：
Abbott, J. Dawn;Ahmed, Hanna N.;Williams, David O.
越来越多的ST段抬高型心肌梗死（STEMI）和非STEMI（NSTEMI）患者接受经皮冠状动脉介入治疗（PCI），我们试图确定MI类型的不良结局风险。对1999年至2004年入选国家心肺血液研究所动态登记处的急性心肌梗死患者进行了研究，这些患者是PCI的适应症。根据就诊时ST段抬高（STEMI，n = 903; NSTEMI，n = 0.583）比较基线数据和院内及1年结局。与NSTEMI患者相比，STEMI患者更年轻，合并症更少，冠状动脉疾病更少。MI类型的血管造影成功率和围手术期并发症相似。STEMI患者的院内冠状动脉旁路移植术、卒中、出血和复发性MI相似，但死亡率较高（4.0% vs 1.4%，p = 0.004）。心源性休克与院内死亡风险最大相关（优势比26.7，95%置信区间11.4 - 62.3，p = 0.0001），但STEMI也是死亡率的独立预测因素。第1年时，MI类型对结局无影响。年龄、心源性休克、肾脏疾病、外周血管疾病和癌症是死亡和心肌梗死的预测因素。多支血管病变和> 50%的大量病变与需要重复血运重建相关。总之，STEMI与院内死亡的可能性高于NSTEMI，但PCI后的长期结局与MI类型无关。在第1年，相关的合并症与死亡和心肌梗死密切相关，而只有血管造影特征预测需要重复血运重建。(C)2007爱思唯尔公司All rights reserved.
Patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are increasingly being treated with percutaneous coronary intervention (PCI) and we sought to determine risk of adverse outcomes by type of MI. Patients enrolled in the National Heart, Lung, and Blood Institute Dynamic Registry from 1999 to 2004 who presented with an acute MI as an indication for PCI were studied. Baseline data and in-hospital and 1-year outcomes were compared based on ST-segment elevation (STEMI, n = 903; NSTEMI, n =.583) at presentation. Patients with STEMI were younger, had fewer co-morbidities, and had less extensive coronary artery disease than did patients with NSTEMI. Angiographic success and periprocedural complications were similar by MI type. In-hospital coronary artery bypass grafting, stroke, bleeding and recurrent MI were similar but mortality was higher in patients with STEMI (4.0% vs 1.4%, p = 0.004). Cardiogenic shock was associated with the greatest risk of in-hospital death (odds ratio 26.7, 95% confidence interval 11.4 to 62.3, p = 0.0001), but STEMI was also independently predictive of mortality. At I year, there was no influence of MI type on outcome. Age, cardiogenic shock, renal disease, peripheral vascular disease, and cancer were predictive of death and MI. Multivessel disease and a larger number of > 50% lesions were associated with the need for repeat revascularization. In conclusion, STEMI was associated with a higher likelihood of in-hospital death than was NSTEMI, but long-term outcomes after PCI were independent of MI type. At I year, associated co-morbidities were strongly associated with death and MI, whereas only angiographic characteristics predicted the need for repeat revascularization. (C) 2007 Elsevier Inc. All rights reserved.