Department of Cardiology, Institute Cardiovascular of Rosario, Rosario, Santa Fe, Argentina.
J Interv Cardiol. 2009 Aug;22(4):329-35. doi: 10.1111/j.1540-8183.2009.00477.x. Epub 2009 Jun 8.
To investigate the major cardiac events at 1-year follow-up of multivessel versus culprit-vessel stenting in patients presenting with non-ST elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD).
Percutaneous coronary intervention is a standard revascularization strategy for patients with NSTE-ACS. However, when these patients have MVD it is not clear whether multivessel (MVR) is superior to culprit-vessel revascularization (CVR).
We screened 1,100 consecutive patients with NSTE-ACS from an institutional database. Comparisons of 1-year outcomes between multivessel and culprit-vessel revascularized patients were made. The primary outcome was the composite (MACE) of death, myocardial infarction (MI), or any revascularization. Secondary end-points were the components of the composite end-point. Regression analysis was performed to detect predictors of MACE.
A total of 609 patients were considered for this analysis: 204 (33.5%) and 405 (66.5%) had MVR and CVR treatment, respectively. The strategy adopted was based on a clinical decision. The incidence of MACE was lower in MVR (9.45% vs. 16.34%, P = 0.02) with lower revascularization rate (7.46% vs. 13.86%, P = 0.04) than in CVR. There was no difference in death (1.99% vs. 1.98%, P = 0.8) nor death/MI (2.49% vs. 3.22%, P = 0.8) between MVR and CVR, respectively. Multivariate analysis showed CVR as the only independent predictor of improved MACE (OR 0.66, CI95% 1.12-3.47, P = 0.01).
Multivessel stenting in patients with NSTE-ACS and multivessel disease using a clinical decision of treatment is associated with lower rate of MACE driven by lower repeat revascularization, compared with culprit-vessel stenting, without difference in rates of death or MI.
研究非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）和多血管病变（MVD）患者 1 年随访时多血管病变（MVR）与罪犯血管血运重建（CVR）的主要心脏事件。
经皮冠状动脉介入治疗是 NSTE-ACS 患者的标准血运重建策略。然而，当这些患者存在 MVD 时，多血管病变（MVR）是否优于罪犯血管血运重建（CVR）并不清楚。
我们从机构数据库中筛选了 1100 例连续的 NSTE-ACS 患者。比较了多血管病变和罪犯血管血运重建患者 1 年的结果。主要结局是死亡、心肌梗死（MI）或任何血运重建的复合（MACE）。次要终点是复合终点的组成部分。进行回归分析以检测 MACE 的预测因素。
共有 609 例患者符合本分析条件：204 例（33.5%）和 405 例（66.5%）分别接受 MVR 和 CVR 治疗。采用的策略是基于临床决策。MVR 的 MACE 发生率较低（9.45% vs. 16.34%，P = 0.02），再血管化率也较低（7.46% vs. 13.86%，P = 0.04）。MVR 与 CVR 之间在死亡率（1.99% vs. 1.98%，P = 0.8）和死亡率/心肌梗死（2.49% vs. 3.22%，P = 0.8）方面均无差异。多变量分析显示，CVR 是 MACE 改善的唯一独立预测因素（OR 0.66，95%CI 1.12-3.47，P = 0.01）。
在多血管病变的 NSTE-ACS 患者中，根据临床决策进行多血管病变血运重建与罪犯血管血运重建相比，与较低的重复血运重建率相关，导致 MACE 发生率降低，而死亡率或 MI 发生率无差异。
