经皮冠状动脉介入治疗急性心肌梗死患者实现完全血运重建的重要性。

Importance of complete revascularization in patients with acute myocardial infarction treated with percutaneous coronary intervention.

作者信息

Kalarus Zbigniew, Lenarczyk Radosław, Kowalczyk Jacek, Kowalski Oskar, Gasior Mariusz, Was Tomasz, Zebik Tadeusz, Krupa Hubert, Chodór Piotr, Poloński Lech, Zembala Marian

机构信息

First Department of Cardiology, Silesian Medical School, Silesian Center for Heart Disease, Zabrze, Poland.

出版信息

Am Heart J. 2007 Feb;153(2):304-12. doi: 10.1016/j.ahj.2006.10.033.

DOI:10.1016/j.ahj.2006.10.033

PMID:17239694

Abstract

BACKGROUND

The role of incomplete revascularization (ICR) in patients with acute myocardial infarction (AMI) is controversial. We evaluated the impact of ICR on short- and long-term outcome in patients with AMI and multivessel disease (MVD) treated with percutaneous coronary interventions (PCI) during index hospital stay.

METHODS

Single-center observational study covered 798 patients with MVD selected from 1486 consecutive patients with AMI treated with PCI. At discharge, 605 (75.8%) of the patients still had at least 1 diseased artery (ICR group); in 193, complete revascularization (CR) has been achieved (CR group). Any-cause mortality rate and major adverse cardiac events (MACE) during hospitalization, within a follow-up period of 30 days and 29.7 months, were compared between both groups in the whole population and within the high-risk subgroups. Propensity model to predict the probability of CR according to 16 variables was used.

RESULTS

Mortality and MACE rates were significantly higher in ICR group than among completely revascularized subjects during short- and long-term observation (remote mortality 18.5% vs 7.2%, MACE 53.1% vs 24.3%, both P < .001). Higher mortality rate was also observed within the subgroups with diabetes (25.2% vs 4.8%), renal dysfunction (44.1% vs 13.8%), and lowered ejection fraction (26.5% vs 10.5%, all P < .05). Propensity-adjusted multivariate analysis showed that ICR was a significant and strong predictor of remote death (propensity-adjusted hazard ratio 2.01, 95% CI 1.71-2.31, P = .02) and MACE (hazard ratio 2.08, 95% CI 1.90-2.26, P < .001).

CONCLUSIONS

Incomplete revascularization is a strong and independent risk factor of death and MACE in patients with AMI treated with PCI.

摘要

背景

不完全血运重建（ICR）在急性心肌梗死（AMI）患者中的作用存在争议。我们评估了ICR对在首次住院期间接受经皮冠状动脉介入治疗（PCI）的AMI合并多支血管病变（MVD）患者短期和长期预后的影响。

方法

单中心观察性研究纳入了从1486例连续接受PCI治疗的AMI患者中选取的798例MVD患者。出院时，605例（75.8%）患者仍有至少1条病变血管（ICR组）；193例实现了完全血运重建（CR组）。比较了两组在全人群以及高危亚组中住院期间、30天随访期和29.7个月随访期内的全因死亡率和主要不良心脏事件（MACE）。使用倾向模型根据16个变量预测CR的概率。

结果

在短期和长期观察中，ICR组的死亡率和MACE发生率显著高于完全血运重建的患者（远期死亡率18.5%对7.2%，MACE 53.1%对24.3%，均P <.001）。在糖尿病亚组（25.2%对4.8%）、肾功能不全亚组（44.1%对13.8%）和射血分数降低亚组（26.5%对10.5%，均P <.05）中也观察到较高的死亡率。倾向调整多因素分析显示，ICR是远期死亡（倾向调整风险比2.01，95%CI 1.71 - 2.31，P =.02）和MACE（风险比2.08，95%CI 1.90 - 2.26，P <.001）的显著且强有力的预测因素。