Abstract：
BACKGROUND: The clinical outcomes of ST-segment elevation myocardial infarction (STEMI) due to the occlusion of left coronary artery are worse in patients with proximal occlusion than in those with non-proximal occlusion. However, there are few reports that focus on the comparison of clinical outcomes in patients with STEMI between proximal and non-proximal right coronary artery (RCA) occlusions.
METHODS: We included 356 patients with STEMI whose infarct-related artery is RCA and divided them into the proximal group (n = 129) and the non-proximal group (n = 227). We defined segment 1 of RCA as proximal, and segments 2, 3, and 4 as non-proximal according to the reporting system of the American Heart Association. The primary endpoint was major cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization.
RESULTS: Incidence of shock at admission, requirement for catecholamine during percutaneous coronary intervention (PCI), or mechanical support during PCI tended to be higher in the proximal group (42.6 %) than in the non-proximal group (33.5 %) (p = 0.088). Although the incidence of right ventricular infarction tended to be higher in the proximal group (17.8 %) than in the non-proximal group (10.6 %) without reaching statistical significance (p = 0.072), the incidence of in-hospital death was similar between the 2 groups (1.6 % versus 1.8 %, p = 1.000). The MACE-free survival curves were not different between the 2 groups (p = 0.400). Multivariate Cox hazard analysis revealed that proximal RCA occlusion was not associated with MACE (HR 1.095, 95%CI 0.691-1.737, p = 0.699).
CONCLUSIONS: Although the acute phase conditions such as shock or right ventricular infarction tended to be more severe in patients with proximal occlusion, overall clinical outcomes including long-term outcomes were comparable between the proximal and distal RCA occlusions. Furthermore, multivariate analysis showed that the proximal RCA occlusion was not associated with MACE after hospital discharge.
METHODS: We included 356 patients with STEMI whose infarct-related artery is RCA and divided them into the proximal group (n = 129) and the non-proximal group (n = 227). We defined segment 1 of RCA as proximal, and segments 2, 3, and 4 as non-proximal according to the reporting system of the American Heart Association. The primary endpoint was major cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization.
RESULTS: Incidence of shock at admission, requirement for catecholamine during percutaneous coronary intervention (PCI), or mechanical support during PCI tended to be higher in the proximal group (42.6 %) than in the non-proximal group (33.5 %) (p = 0.088). Although the incidence of right ventricular infarction tended to be higher in the proximal group (17.8 %) than in the non-proximal group (10.6 %) without reaching statistical significance (p = 0.072), the incidence of in-hospital death was similar between the 2 groups (1.6 % versus 1.8 %, p = 1.000). The MACE-free survival curves were not different between the 2 groups (p = 0.400). Multivariate Cox hazard analysis revealed that proximal RCA occlusion was not associated with MACE (HR 1.095, 95%CI 0.691-1.737, p = 0.699).
CONCLUSIONS: Although the acute phase conditions such as shock or right ventricular infarction tended to be more severe in patients with proximal occlusion, overall clinical outcomes including long-term outcomes were comparable between the proximal and distal RCA occlusions. Furthermore, multivariate analysis showed that the proximal RCA occlusion was not associated with MACE after hospital discharge.
摘要：
背景：由于左冠状动脉闭塞引起的ST段抬高型心肌梗死（STEMI）的临床结果在近端闭塞患者中比非近端闭塞患者差。然而,很少有报道关注STEMI患者近端和非近端右冠状动脉(RCA)闭塞的临床结局的比较.
方法：我们纳入了356例心肌梗死相关动脉为RCA的STEMI患者，并将其分为近端组（n=129）和非近端组（n=227）。我们将RCA的第1段定义为近端，根据美国心脏协会的报告系统，第2、3和4段为非近端。主要终点是主要心血管事件（MACE），它被定义为全因死亡的复合物，非致死性心肌梗死,因心力衰竭再次入院,和缺血驱动的靶血管血运重建。
结果：入院时休克的发生率，经皮冠状动脉介入治疗（PCI）期间对儿茶酚胺的需求，PCI期间或机械支持在近端组(42.6%)高于非近端组(33.5%)(p=0.088).尽管右心室梗死的发生率在近端组（17.8%）高于非近端组（10.6%），但没有达到统计学意义（p=0.072），两组的院内死亡发生率相似(1.6%对1.8%,p=1.000)。两组无MACE生存曲线无差异(p=0.400)。多变量Cox风险分析显示，近端RCA闭塞与MACE无关（HR1.095，95CI0.691-1.737，p=0.699）。
结论：尽管急性时相疾病如休克或右心室梗死倾向于在近端闭塞患者中更为严重，包括长期结局在内的总体临床结局在近端和远端RCA闭塞之间具有可比性.此外，多因素分析显示，近端RCA闭塞与出院后的MACE无关。
方法：我们纳入了356例心肌梗死相关动脉为RCA的STEMI患者，并将其分为近端组（n=129）和非近端组（n=227）。我们将RCA的第1段定义为近端，根据美国心脏协会的报告系统，第2、3和4段为非近端。主要终点是主要心血管事件（MACE），它被定义为全因死亡的复合物，非致死性心肌梗死,因心力衰竭再次入院,和缺血驱动的靶血管血运重建。
结果：入院时休克的发生率，经皮冠状动脉介入治疗（PCI）期间对儿茶酚胺的需求，PCI期间或机械支持在近端组(42.6%)高于非近端组(33.5%)(p=0.088).尽管右心室梗死的发生率在近端组（17.8%）高于非近端组（10.6%），但没有达到统计学意义（p=0.072），两组的院内死亡发生率相似(1.6%对1.8%,p=1.000)。两组无MACE生存曲线无差异(p=0.400)。多变量Cox风险分析显示，近端RCA闭塞与MACE无关（HR1.095，95CI0.691-1.737，p=0.699）。
结论：尽管急性时相疾病如休克或右心室梗死倾向于在近端闭塞患者中更为严重，包括长期结局在内的总体临床结局在近端和远端RCA闭塞之间具有可比性.此外，多因素分析显示，近端RCA闭塞与出院后的MACE无关。
