Varani Elisabetta, Balducelli Marco, Aquilina Matteo, Vecchi Giuseppe, Hussien Mohamed Naseem, Frassineti Valeria, Maresta Aleardo
Department of Cardiology, S. Maria delle Croci Hospital, Ravenna, Italy.
Catheter Cardiovasc Interv. 2008 Dec 1;72(7):927-33. doi: 10.1002/ccd.21722.
To evaluate clinical results of percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) in patients with multivessel disease (MVD), in relation to single or multivessel (MV)-PCI and to patients with single vessel disease (SVD).
Patients treated with PCI in the setting of <24 hr STEMI in the years 2004-2007 were considered.
Seven hundred forty-five primary PCI, 346 (46%) in patients with SVD and 399 (54%) in patients with MVD were performed. Among MVD patients, 156 (39%) had infarct related artery (IRA)-only treatment and 243 had MV-PCI: 147 (37%) in a single session, 48 (12%) within 24 hr, and 48 (12%) predischarge. Revascularization was complete in 46% of MVD patients. At a median follow-up of 597 days, mortality was 6.3% in SVD and 12% in MVD (P = 0.007), new revascularization 2.9% and 9%, respectively (P < 0.001). Thirty-day mortality was 2.4% in SVD and 6.7% in MVD (P = 0.006). After exclusion of patients with cardiogenic shock or pulmonary oedema, more frequent in the MV-PCI in single session group (P = 0.006), 30-day mortality was SVD 1.3%, IRA-only 6.3%, MV-PCI 2.8% (P = 0.023), without differences if in a single (3.3%) or in staged session (2.2%). By multivariate analysis, female sex, anterior STEMI, cardiogenic shock, MVD, and procedural failure were independent predictors of 30-day mortality.
STEMI patients with MVD have a worse prognosis than those with SVD. MV-PCI in patients without hemodynamic compromise yields good short-term results, even if performed very early, with a 30-day mortality in between that of SVD patients and that of MVD patients with IRA-only treatment.
评估多支血管病变（MVD）的ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）的临床结果，比较单支血管或多支血管（MV）-PCI与单支血管病变（SVD）患者的情况。
纳入2004年至2007年期间在<24小时STEMI情况下接受PCI治疗的患者。
共进行了745例直接PCI，其中346例（46%）为SVD患者，399例（54%）为MVD患者。在MVD患者中，156例（39%）仅对梗死相关动脉（IRA）进行了治疗，243例接受了MV-PCI：147例（37%）在单次手术中进行，48例（12%）在24小时内进行，48例（12%）在出院前进行。46%的MVD患者血运重建完成。在中位随访597天时，SVD患者的死亡率为6.3%，MVD患者为12%（P = 0.007），再次血运重建率分别为2.9%和9%（P < 0.001）。30天死亡率SVD患者为2.4%，MVD患者为6.7%（P = 0.006）。排除心源性休克或肺水肿患者后（单次MV-PCI组中此类患者更常见，P = 0.006），30天死亡率SVD患者为1.3%，仅IRA治疗患者为6.3%，MV-PCI患者为2.8%（P = 0.023），单次手术（3.3%）或分期手术（2.2%）之间无差异。多因素分析显示，女性、前壁STEMI、心源性休克、MVD和手术失败是30天死亡率的独立预测因素。
MVD的STEMI患者预后比SVD患者差。在无血流动力学障碍的患者中，MV-PCI即使在非常早期进行也能产生良好的短期结果，其30天死亡率介于SVD患者和仅IRA治疗的MVD患者之间。
