医学
心源性休克
心脏病学
蒂米
内科学
心肌梗塞
射血分数
ST高程
经皮冠状动脉介入治疗
心力衰竭
作者
Mohammed ABUSHAREKH,Jürgen Kampf,Iryna Dykun,Kashif Souri,Viktoria Backmann,Fadi Al–Rashid,Rolf Alexander Jánosi,Matthias Totzeck,Thomas Lawo,Tienush Rassaf,Amir A. Mahabadi
出处
期刊:European Heart Journal - Quality of Care and Clinical Outcomes
[Oxford University Press]
日期:2024-01-08
标识
DOI:10.1093/ehjqcco/qcae003
摘要
Abstract Background Acute total occlusion (ATO) is diagnosed in a substantial proportion of patients with non-ST-elevation myocardial infarction (NSTEMI). We compared procedural outcomes and long-term mortality in patients with STEMI with NSTEMI with vs. without ATO. Methods and results We included patients with acute myocardial infarction (AMI) undergoing invasive coronary angiography between 2004 and 2019 at our centre. Acute total occlusion was defined as thrombolysis in myocardial infarction (TIMI) 0–1 flow in the infarct-related artery or TIMI 2–3 flow with highly elevated peak troponin (>100-folds the upper reference limit). Association between presentation and long-term mortality was evaluated using multivariable adjusted Cox regression analysis. From 2269 AMI patients (mean age 66 ± 13.2 years, 74% male), 664 patients with STEMI and 1605 patients with NSTEMI (471 [29.3%] with ATO) were included. ATO(+)NSTEMI patients had a higher frequency of cardiogenic shock and no reflow than ATO(−)NSTEMI with similar rates compared with STEMI patients (cardiogenic shock: 2.76 vs. 0.27 vs. 2.86%, P < 0.0001, P = 1; no reflow: 4.03 vs. 0.18 vs. 3.17%, P < 0.0001, P = 0.54). ATO(+)NSTEMI and STEMI were associated with 60 and 55% increased incident mortality, respectively, as compared with ATO(−)NSTEMI (ATO(+)NSTEMI: 1.60 [1.27–2.02], P < 0.0001, STEMI: 1.55 [1.24–1.94], P < 0.0001). Likewise, left ventricular ejection fraction (48.5 ± 12.7 vs. 49.1±11 vs. 50.6 ± 11.8%, P = 0.5, P = 0.018) and global longitudinal strain (−15.2 ± –5.74 vs. −15.5 ± –4.84 vs. −16.3 ± –5.30%, P = 0.48, P = 0.016) in ATO(+)NSTEMI were comparable to STEMI but significantly worse than in ATO(−)NSTEMI. Conclusion Non-ST-elevation myocardial infarction patients with ATO have unfavourable procedural outcomes, resulting in increased long-term mortality, resembling STEMI. Our findings suggest that the occlusion perspective provides a more appropriate classification of AMI than differentiation into STEMI vs. NSTEMI.
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