本邦における左主幹部急性心筋梗塞の臨床的特徴と予後

概要

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Acute myocardial infarction caused by an occlusion of the left main trunk (LMT-AMI) has poor prognosis and it has been an important issue to clarify the clinical background and determine the optimal therapeutic strategy in the field of cardiac intensive care. To evaluate the clinical profiles, therapeutic strategy and prognosis of LMT-AMI, we analyzed 3,021 patients with AMI who were enrolled in Heart Institute of Japan Acute Myocardial Infarction [HIJAMI] registry between 1999 January and 2001 June. Of whom, 48 patients with LMT-AMI (1.6%) were reviewed. Within 24 hours after the onset, the reperfusion therapy was conducted in 37 patients (77.1%) with coronary thrombolysis (20.8%), percutaneous coronary intervention (PCI, 50.4%), and coronary artery bypass grafting (CABG, 18.8%). The CABG tended to be chosen incase with stable circulatory status. The inhospital mortality was 50.0% and the long term (median 4.3 years) mortality was 60.4%. The circulatory status at hospital arrival and the thrombolysis in myocardial infarction (TIMI) flow grade were strong predictors of mortality rate. Therefore, the importance should be re-emphasized to make early diagnosis and, early and certain revascularization before the circulatory collapse in the emergent case of LMT-AMI.
東京女子医科大学の論文