Impact of Nonculprit Vessel Myocardial Perfusion on Outcomes of Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes Analysis From the ACUITY Trial (Acute Catheterization and Urgent Intervention Triage Strategy)

被引：2

作者：

Lansky, Alexandra J. ^{[1
]}

Ng, Vivian G. ^{[1
]}

Meller, Stephanie ^{[1
]}

Xu, Ke ^{[2
,3
]}

Fahy, Martin ^{[2
,3
]}

Feit, Frederick ^{[4
]}

Ohman, E. Magnus ^{[5
]}

White, Harvey D. ^{[6
]}

Mehran, Roxana ^{[7
]}

Bertrand, Michel E. ^{[8
]}

Desmet, Walter ^{[9
]}

Hamon, Martial ^{[10
]}

Stone, Gregg W. ^{[2
,3
]}

机构：

[1] Yale Univ, Sch Med, Div Cardiovasc Med, New Haven, CT 06520 USA

[2] Columbia Univ, Med Ctr, Div Cardiol, New York, NY USA

[3] Cardiovasc Res Fdn, New York, NY USA

[4] NYU, Sch Med, Div Cardiol, New York, NY USA

[5] Duke Univ, Sch Med, Dept Med, Durham, NC 27706 USA

[6] Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand

[7] Mt Sinai Med Ctr, Div Cardiol, New York, NY 10029 USA

[8] Hop Cardiol, Dept Cardiol, F-59037 Lille, France

[9] Univ Hosp Gasthuisberg, Dept Cardiol, B-3000 Leuven, Belgium

[10] Univ Hosp, Dept Cardiol, Normandy, France

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2014年 / 7卷 / 03期

基金：

美国国家卫生研究院;

关键词：

acute coronary syndrome; epicardial flow; mortality; myocardial perfusion; non-culprit vessel; percutaneous coronary intervention; FRACTIONAL FLOW RESERVE; NO-REFLOW PHENOMENON; PRIMARY ANGIOPLASTY; BLOOD-FLOW; CLINICAL-IMPLICATIONS; VASODILATOR FUNCTION; ADHESION MOLECULES; DIABETES-MELLITUS; INFARCTION; ARTERY;

D O I：

10.1016/j.jcin.2013.08.016

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 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. 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 = 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. (C) 2014 by the American College of Cardiology Foundation

引用

页码：266 / 275

页数：10

共 44 条

[31] Antithrombotic strategies in patients with acute coronary syndromes undergoing early invasive management - One-year results from the ACUITY trial [J].

Stone, Gregg W. ;

Ware, James H. ;

Bertrand, Michel E. ;

Lincoff, A. Michael ;

Moses, Jeffrey W. ;

Ohman, E. Magnus ;

White, Harvey D. ;

Feit, Frederick ;

Colombo, Antonio ;

McLaurin, Brent T. ;

Cox, David A. ;

Manoukian, Steven V. ;

Fahy, Martin ;

Clayton, Tim C. ;

Mehran, Roxana ;

Pocock, Stuart J. .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2007, 298 (21) :2497-2506

[32] Acute catheterization and urgent intervention triage strategY (ACUITY) trial: Study design and rationale [J].

Stone, GW ;

Bertrand, M ;

Colombo, A ;

Dangas, G ;

Farkouh, ME ;

Feit, F ;

Lansky, AJ ;

Lincoff, AM ;

Mehran, R ;

Moses, JW ;

Ohman, M ;

White, HD .

AMERICAN HEART JOURNAL, 2004, 148 (05) :764-775

[33] Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction [J].

Stone, GW ;

Peterson, MA ;

Lansky, AJ ;

Dangas, G ;

Mehran, R ;

Leon, MB .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (04) :591-597

[34] Primary percutaneous coronary intervention compared with fibrinolysis for myocardial infarction in diabetes mellitus - Results from the primary coronary angioplasty vs thrombolysis-2 trial [J].

Timmer, Jorik R. ;

Ottervanger, Jan Paul ;

de Boer, Menko-Jan ;

Boersma, Eric ;

Grines, Cindy L. ;

Westerhout, Cynthia M. ;

Simes, John ;

Granger, Christopher B. ;

Zijlstra, Felix .

ARCHIVES OF INTERNAL MEDICINE, 2007, 167 (13) :1353-1359

[35] Recognition of the importance of embolization in atherosclerotic vascular disease [J].

Topol, EJ ;

Yadav, JS .

CIRCULATION, 2000, 101 (05) :570-580

[36] ALTERED CORONARY VASODILATOR RESERVE AND METABOLISM IN MYOCARDIUM SUBTENDED BY NORMAL ARTERIES IN PATIENTS WITH CORONARY-ARTERY DISEASE [J].

UREN, NG ;

MARRACCINI, P ;

GISTRI, R ;

DESILVA, R ;

CAMICI, PG .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 22 (03) :650-658

[37] REDUCED CORONARY VASODILATOR FUNCTION IN INFARCTED AND NORMAL MYOCARDIUM AFTER MYOCARDIAL-INFARCTION [J].

UREN, NG ;

CRAKE, T ;

LEFROY, DC ;

DESILVA, R ;

DAVIES, GJ ;

MASERI, A .

NEW ENGLAND JOURNAL OF MEDICINE, 1994, 331 (04) :222-227

[38] Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction - Myocardial blush grade [J].

van't Hof, AWJ ;

Liem, A ;

Suryapranata, H ;

Hoorntje, JCA ;

de Boer, MJ ;

Zijlstra, F .

CIRCULATION, 1998, 97 (23) :2302-2306

[39] SITE OF INTIMAL RUPTURE OR EROSION OF THROMBOSED CORONARY ATHEROSCLEROTIC PLAQUES IS CHARACTERIZED BY AN INFLAMMATORY PROCESS IRRESPECTIVE OF THE DOMINANT PLAQUE MORPHOLOGY [J].

VANDERWAL, AC ;

BECKER, AE ;

VANDERLOOS, CM ;

DAS, PK .

CIRCULATION, 1994, 89 (01) :36-44

[40] Short- and long-term risk stratification in acute coronary syndromes - The added value of quantitative ST-segment depression and multiple biomarkers [J].

Westerhout, Cynthia M. ;

Fu, Yuling ;

Lauer, Michael S. ;

James, Stefan ;

Armstrong, Paul W. ;

Al-Hattab, Eyad ;

Califf, Robert M. ;

Simoons, Maarten L. ;

Wallentin, Lars ;

Boersma, Eric .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 48 (05) :939-947

← 1 2 3 4 5 →