- 作者：Alexandra J. Lansky ; MD&lowast ; ; alexandra.lansky@yale.edu" class="auth_mail ; Vivian G. Ng ; MD&lowast ; ; Stephanie Meller ; MD&lowast ; ; Ke Xu ; PhD&dagger ; ; Martin Fahy ; MSc&dagger ; ; Frederick Feit ; MD&Dagger ; ; E. Magnus Ohman ; MD§ ; ; Harvey D. White ; MD鈥?/sup> ; Roxana Mehran ; MD¶ ; ; Michel E. Bertrand ; MD# ; Walter Desmet ; MD&lowast ; &lowast ; ; Martial Hamon ; MD&dagger ; &dagger ; ; Gregg W. Stone ; MD&dagger ;
- 关键词：acute coronary syndrome ; epicardial flow ; mortality ; myocardial perfusion ; non-culprit vessel ; percutaneous coronary intervention
- 刊名：JACC: Cardiovascular Interventions
- 出版年：March, 2014
- 年：2014
- 卷：7
- 期：3
- 页码：266-275
- 全文大小：532 K
Objectives
This study evaluated the impact of nonculprit vessel myocardial perfusion on outcomes of non-ST-segment elevation acute coronary syndromes (NSTE-ACS) patients.Background
ST-segment elevation myocardial infarction patients have decreased perfusion in areas remote from the infarct-related vessel. The impact of myocardial hypoperfusion of regions supplied by nonculprit vessels in NSTE-ACS patients treated with percutaneous coronary intervention (PCI) is unknown.
Methods
The angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial included 6,921 NSTE-ACS patients. Complete 3-vessel assessments of baseline coronary TIMI (Thrombolysis In Myocardial Infarction) flow grade and myocardial blush grade (MBG) were performed. We examined the outcomes of PCI-treated patients according to the worst nonculprit vessel MBG identified per patient.
Results
Among the 3,826 patients treated with PCI, the worst nonculprit MBG was determined in聽3,426 (89.5%) patients, including 375 (10.9%) MBG 0/1 patients, 475 (13.9%) MBG 2 patients, and 2,576 (75.2%) MBG 3 patients. Nonculprit MBG 0/1 was associated with worse baseline clinical characteristics. Patients with nonculprit MBG 0/1 versus MBG 3 had increased rates of 30-day (3.0% vs.聽0.7%, p < 0.0001) and 1-year (4.4% vs. 1.0%, p < 0.0001) death. Similar results were found among patients with pre-procedural TIMI flow grade 3 in the culprit vessel, where nonculprit vessel MBG 0/1 (hazard ratio: 2.81 [95% confidence interval: 1.63 to 4.84], p聽= 0.0002) was the strongest predictor of 1-year mortality.
Conclusions
Reduced myocardial perfusion in an area supplied by a nonculprit vessel is associated with increased short- and long-term mortality rates in NSTE-ACS patients undergoing PCI. Furthermore, worst nonculprit MBG is able to risk-stratify patients with normal baseline flow of the culprit vessel.