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首页> 外文期刊>The American Journal of Cardiology >Long term prognostic value of subclinical carotid and femoral arterial wall lesions in patients with ST-elevation-myocardial infarction having percutaneous coronary intervention
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Long term prognostic value of subclinical carotid and femoral arterial wall lesions in patients with ST-elevation-myocardial infarction having percutaneous coronary intervention

机译：经皮冠状动脉介入治疗ST抬高型心肌梗死患者亚临床颈动脉和股动脉壁病变的长期预后价值

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The presence of clinical peripheral arterial disease (PAD) is associated with an increased risk for adverse cardiovascular outcomes in patients with coronary artery disease. However, there are few data regarding the impact of the presence and degree of the subclinical PAD on outcomes in patients with coronary artery disease. The aim of this study was to assess prospectively the grade of subclinical PAD in the setting of patients who underwent primary percutaneous coronary intervention for the prediction of intermediate- and long-term clinical outcomes. A total of 971 consecutive patients without histories of clinical PAD who under went primary percutaneous coronary intervention for ST-segment elevation myocardial infarction were included in a prospective follow-up. Subclinical PAD severity was blindly assessed on the basis of an ultrasound arterial morphologic classification defined with the assessment of wall carotid and femoral artery bifurcations. This classification included 4 increasing classes of subclinical carotid and femoral arterial wall lesions, and the total group was divided accordingly. Death and major cardiovascular and cerebrovascular events were evaluated. During a median follow-up period of 40 months, a total of 109 patients (11.2%) died, 9 (2.8%) in class I, 12 (3.1%) in class II, 37 (23.7%) in class III, and 51 (49.0%) in class IV (p <0.001). On multivariate analysis, mortality in class IV was sevenfold higher (hazard ratio [HR] 7.34, 95% confidence interval [CI] 3.3 to 16.33, p <0.001) compared to class I and was also increased in class III (HR 5.38, 95% CI 2.42 to 11.92, p <0.001). Similar results were obtained for major adverse cardiovascular and cerebrovascular events in class IV (HR 7.50, 95% confidence interval 5.36 to 10.50, p <0.0001), class III (HR 6.44, 95% CI 4.45 to 9.32, p <0.001), and class II (HR 1.73, 95% CI 1.23 to 2.43, p = 0.002). In conclusion, ultrasound arterial morphologic classification may be applied in patients with ST-segment elevation myocardial infarctions who undergo primary percutaneous coronary intervention and can stratify patients for poor clinical outcomes during long-term follow-up. ? 2013 Elsevier Inc. All rights reserved.
机译：临床周围动脉疾病（PAD）的存在与冠心病患者心血管不良结局的风险增加相关。但是，关于亚临床PAD的存在和程度对冠心病患者预后的影响的数据很少。这项研究的目的是前瞻性评估接受初次经皮冠状动脉介入治疗以预测中长期临床结局的患者中亚临床PAD的等级。前瞻性随访包括总共971例无临床PAD病史的患者，这些患者因ST段抬高型心肌梗死接受了首次经皮冠状动脉介入治疗。在超声动脉形态学分类的基础上盲目评估亚临床PAD的严重程度，该分类定义为评估颈动脉壁和股动脉分叉。此分类包括4个递增的亚临床颈动脉和股动脉壁病变类别，并且相应地将整个组划分。评估了死亡以及主要的心血管和脑血管事件。在40个月的中位随访期内，共有109例患者（11.2％）死亡，I级9例（2.8％），II级12例（3.1％），III级37例（23.7％），以及IV级为51（49.0％）（p <0.001）。在多变量分析中，与第一级相比，第四级的死亡率高出七倍（危险比[HR] 7.34，95％置信区间[CI] 3.3至16.33，p <0.001），并且在第三级也有所提高（HR 5.38、95 ％CI 2.42至11.92，p <0.001）。在IV级（HR 7.50，95％置信区间5.36至10.50，p <0.0001），III级（HR 6.44，95％CI 4.45至9.32，p <0.001）中，重大心血管和脑血管不良事件获得了相似的结果II级（HR 1.73，95％CI 1.23至2.43，p = 0.002）。综上所述，超声动脉形态学分类可能适用于ST段抬高型心肌梗死的患者，这些患者接受了主要的经皮冠状动脉介入治疗，并且可以对长期随访中不良的临床结果进行分层。 ？ 2013 Elsevier Inc.保留所有权利。

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