Qarawani Dahud, Nahir Menachem, Abboud Mouin, Hazanov Yevgeny, Hasin Yonathan
Cardiovascular Department, Poria Medical Center, Israel.
Int J Cardiol. 2008 Jan 24;123(3):288-92. doi: 10.1016/j.ijcard.2006.12.013. Epub 2007 Apr 10.
Primary percutaneous intervention (PCI) is the treatment of choice for acute ST elevation myocardial infarction. Currently it is recommended to treat only the culprit artery during the acute procedure. Only few reports describe the results of simultaneous non-culprit vessel PCI. The study hypothesizes that complete revascularization during primary PCI can be achieved safely with an improved clinical outcome during the indexed hospitalization.
One hundred and twenty consecutive patients presented with acute ST elevation myocardial infarction (STEMI) and multivessel coronary stenosis. Ninety five underwent complete revascularization (CR): the culprit artery was opened first followed by dilatation of the other significantly narrowed arteries. Twenty five had culprit only revascularization (COR): the culprit artery only was dilated and the other arteries were left untreated during the primary PCI.
Complete revascularization (CR) was associated with reduced incidence of major cardiac events (recurrent ischemia, reinfarction, acute heart failure and in-hospital mortality 16.7 versus 52%, P=0.0001). There was a significant lower rate of recurrent ischemic episodes (4.2% versus 32%, P=0.002), myocardial reinfarction (3.1% versus 16%, P=0.01), reintervention (7.3% versus 32%, P=0.001), acute heart failure (9.4% versus 32%, P=0.01) during the indexed hospitalization and shorter hospitalization (4.4+/-1.27 versus 9.6+/-2.3, P=0.001) in the CR group. Transient renal dysfunction was more common in CR patients (8.4% versus 4% P=0.01). In-hospital and one year mortality were similar between the two groups.
Multivessel PCI during acute myocardial infarction is feasible and safe. Complete revascularization resulted in an improved acute clinical course. These data support a policy of complete revascularization during primary PCI for STEMI.
直接经皮冠状动脉介入治疗（PCI）是急性ST段抬高型心肌梗死的首选治疗方法。目前建议在急性期手术中仅治疗罪犯血管。仅有少数报告描述了同期非罪犯血管PCI的结果。该研究假设在直接PCI期间实现完全血运重建可安全进行，并能改善本次住院期间的临床结局。
连续纳入120例急性ST段抬高型心肌梗死（STEMI）合并多支冠状动脉狭窄的患者。95例行完全血运重建（CR）：先开通罪犯血管，随后对其他明显狭窄的血管进行扩张。25例行仅罪犯血管血运重建（COR）：在直接PCI期间仅扩张罪犯血管，其他血管不予处理。
完全血运重建（CR）与主要心脏事件发生率降低相关（复发缺血、再梗死、急性心力衰竭和住院死亡率分别为16.7%和52%，P = 0.0001）。在本次住院期间，CR组复发缺血事件发生率显著较低（4.2%对32%，P = 0.002）、心肌再梗死发生率较低（3.1%对16%，P = 0.01）、再次干预率较低（7.3%对32%，P = 0.001）、急性心力衰竭发生率较低（9.4%对32%，P = 0.01），且住院时间较短（4.4±1.27天对9.6±2.3天，P = 0.001）。CR患者中短暂性肾功能不全更为常见（8.4%对4%，P = 0.01）。两组的住院死亡率和1年死亡率相似。
急性心肌梗死期间多支血管PCI是可行且安全的。完全血运重建可改善急性临床病程。这些数据支持对STEMI患者在直接PCI期间进行完全血运重建的策略。
