冠動脈主要3枝に完全閉塞を認めた急性心筋梗塞症の院内予後

Outcome of a Patient With Acute Myocardial Infarction, Showing Obstructions in Three Main Coronary Branches

　急性心筋梗塞症（AMI）において冠動脈造影上，主要冠動脈3枝閉塞は稀であり詳しく検討されていない．そこで3枝閉塞を認めたAMIの患者につき，院内予後を規定する因子について検討した．主要冠動脈3枝に閉塞を認めたAMIの31例を，院内死亡群と生存退院群に分け，比較検討した．また，院内死亡の規定因子についても検討した．院内死亡群では，心不全発症例，左前下行枝近位部閉塞，急性期再灌流療法（PTCA）不成功が有意に高率であった（p＜0.05）．多変量解析では，左前下行枝近位部閉塞が院内死亡に対して高いハザード比を示し，右冠動脈近位部閉塞は低いハザード比を示した（p＜0.01）．これらのことから3枝閉塞のAMIでは左前下行枝近位部閉塞が院内死亡を最も規定する因子と考えられた．

　Acute myocardial infarction (AMI) patient with three coronary artery olbstructions is considered to be rare and has poor prognosis. However, in-hospital mortality of these patient has not reported. This study investigated in-hospital mortality of 31 AMI patients showing total obstruction of three main coronary branches. The in hospital death group (n=5) was compared with the survivor group (n=26) with respect to the clinical and angiographical profiles. Patients who died were more likely to have congestive heart failure related to unsuccessfull corollary angioplasty and proximal left ascending artery obstruction (p＜0.05). Multivariate logistic analysis demonstrated that a good predictor of in-hospital mortality was proximal left ascending artery obstruction. Proximal lesion of the right coronary artery was not a predictor of in-hospital mortality (p＜0.01).

　Proximal left anterior descending artery obstruction had the greatest influence on the outcome of patients with AMI showing obstructions of three main coronary branches. Successfull corollary angioplasty was considered to reduce the in-hospital death rate.