2018 年第 5 期 第 13 卷

无保护左主干病变致急性心肌梗死患者临床特征和介入治疗分析

Clinical features of acute myocardial infarction due to unprotected left main coronary artery lesion and the curative effect of coronary intervention

作者：叶绍东祁雨孙中伟赵冬云李萍唐熠达李琳

英文作者：

单位：100037中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科

英文单位：

关键词：急性心肌梗死；冠状动脉造影；危险因素；冠状动脉介入；左主干

英文关键词：

• 摘要：

• 目的    探讨无保护左主干病变所致急性心肌梗死(AMI)患者的临床和冠状动脉造影特征及经皮冠状动脉介入（PCI）治疗效果。方法    连续入选2015年10月至2017年10月就诊于国家心血管病中心阜外医院的AMI患者33例，患者均经冠状动脉造影证实罪犯血管为无保护左主干病变,回顾性分析并比较其临床特征和冠状动脉造影情况及PCI治疗效果。结果    33例左主干病变所致AMI患者男30例，女3例；平均年龄(60±13)岁；ST段抬高型心肌梗死14例（42.4%），病变位于左主干远端及分叉部位28例（84.8%），左主干合并1~3支病变31例（93.9%），SYNTAX评分为（22±7）分，就诊时即出现心源性休克3例（9.1%），术中死亡1例、发生心源性休克4例（12.1%）、出现严重室性心律失常6例，院内病死率3.0%（1/33），1例随访期间死亡，1年内病死率为6.1%（2/33）。主要不良心脑血管事件（MACCE）发生率45.4%（15/33）。根据患者住院及随访期间总的MACCE发生情况分为2组，发生MACCE组15例，未发生MACCE组18例，发生MACCE组既往冠状动脉粥样硬化性心脏病史比例低于未发生MACCE组［13.3%(2/15)比50.0%（9/18）］，冠状动脉解剖SYNTAX评分高危(≥32分)比例高于未发生MACCE组［20.0%(3/15)比0.0%（0/18）］，差异均有统计学意义（均P＜0.05）。结论    左主干病变所致AMI病情危重，易伴发心力衰竭、心源性休克、心室颤动等合并症。冠状动脉病变复杂及时行PCI治疗存活者远期预后较好。基线SYNTAX评分≥32分和无冠状动脉粥样硬化性心脏病史与MACCE事件发生率高有关。

• 【Abstract】Objective    To investigate the clinical and angiographic features of acute myocardial infarction（AMI） caused by unprotected left main coronary artery lesion and the outcomes of patients after percutaneous coronary intervention（PCI）. Methods    Clinical records of 33 consecutive patients diagnosed with AMI and left main was the culprit vessel identified by coronary angiography in Fuwai Hospital, National Center for Cardiovascular Diseases from October 2015 to October 2017 were reviewed. Clinical characteristics, coronary angiographic results and outcomes of PCI were analyzed. Results    There were 30 males and 3 females with an average age of (60±13)years; 14 patients(42.4%) presented with ST-segment elevation myocardial infarction; 28 patients（84.8%） had culprit lesions in distal left main coronary artery; 31 patients（93.9%） had left main and multi-vessel disease; the average SYNTAX score was （22±7）. Cardiac shock was presented in 3 patients（9.1%） before admission to emergency department. During PCI procedure, 1 patient died, 4 patients（12.1%） had cardiac shock and 6 patients had severe ventricular arrhythmia. The hospital mortality rate was 3.0%（1/33）. One patient died during follow-up; the 1-year mortality rate was 6.1%（2/33）. The incidence rate of major adverse cardiovascular and cerebrovascular events(MACCE) was 46.9%（15/33）. Coronary heart disease history rate in MACCE group（n＝15） was significantly lower than that in non-MACCE group（n＝18）［13.3%(2/15) vs 50.0%（9/18）］（P＜0.05）. High SYNTAX score(≥32) rate in MACCE group was significantly higher than that in non-MACCE group［20.0%(3/15) vs 0.0%（0/18）］（P＜0.05）. Conclusions    Patients with AMI caused by left main lesion has high incidences of complications such as heart failure, cardiac shock and ventricular fibrillation. Early PCI can provide a optimistic long-term prognosis of complex coronary artery disease. SYNTAX score≥32 and non-history of coronary heart disease are predictive factors of high MACCE rate.

  【Key words】Acute myocardial infarction;Coronary angiography;Risk factors;Percutaneous coronary intervention;Left main coronary artery