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目的探讨左主干病变导致的急性心肌梗死与心源性休克的关系以及急诊经皮冠状动脉介入对其的疗效。方法1999年9月至2005年6月连续就诊于中国医科大学附属盛京医院心内科并且行急诊冠脉造影的急性心肌梗死患者752例,发现因左主干急性闭塞导致血管床灌注评分(TIMI)血流在2级或2级以下者16例(2.12%),所有患者行急诊经皮冠状动脉介入(PCI)治疗,观察住院期间病死率。结果16例患者中,9例(56.25%)住院期间死亡,7例(43.75%)出院。死亡组再灌注成功率42.86%,生存组为100%,两组间比较差异有显著性意义(P=0.029)。未成功再灌注的5例均由无复流引起,其中3例可见肉眼血栓,5例患者均死亡。16例患者中有12例发生心源性休克,发生率为75.00%,死亡组发生率100%,生存组42.85%,两组间比较差异有显著性意义(P=0.019)。心源性休克患者住院病死率为75.00%高于无休克者,死亡风险是无休克者的4倍[比值比(OR)=4.0,95%可信区间1.50～10.66,P=0.019]。结论左主干闭塞导致的急性心肌梗死患者出现心源性休克的发生率较高,且即使成功地施行了PCI治疗,也有较高的病死率。不过,急诊PCI在临床实践仍然是有效可行的治疗手段,可以有效地挽救部分生命。
Objective To investigate the relationship between acute myocardial infarction (AMI) and cardiogenic shock caused by left main disease and the effect of percutaneous coronary intervention on it. Methods From September 1999 to June 2005, 752 consecutive AMI patients admitted to Department of Cardiology, Shengjing Hospital Affiliated to China Medical University underwent emergency coronary angiography and found that TIMI was caused by acute left main obstruction. Sixteen patients (2.12%) with blood flow below grade 2 or grade 2 underwent emergency percutaneous coronary intervention (PCI). The mortality rate during hospitalization was observed. Results Of 16 patients, 9 (56.25%) died during hospitalization and 7 (43.75%) were discharged. The success rate of reperfusion was 42.86% in death group and 100% in survival group, with significant difference between the two groups (P = 0.029). Five cases of unsuccessful reperfusion were caused by no-reflow, of which, 3 cases showed macroscopic thrombus and 5 patients died. Cardiac shock occurred in 12 of 16 patients, with a prevalence of 75.00%. The incidence of death was 100% and survival was 42.85%. There was significant difference between the two groups (P = 0.019). In-hospital mortality was 75.00% in patients with cardiogenic shock and 4 times the risk of death compared with those without. [OR = 4.0, 95% confidence interval 1.50 to 10.66, P = 0.019]. Conclusion The incidence of cardiogenic shock in patients with acute myocardial infarction caused by left main occlusion is high, and the mortality rate is high even after successful PCI. However, emergency PCI is still an effective and feasible treatment in clinical practice, which can effectively save some lives.