School of Public Health, University at Albany, State University of New York, Albany, New York 12144-3456, USA.
JACC Cardiovasc Interv. 2010 Jan;3(1):22-31. doi: 10.1016/j.jcin.2009.10.017.
The purpose of this study was to examine the differences in in-hospital and longer-term mortality for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent single-vessel (culprit vessel) percutaneous coronary interventions (PCIs) or multivessel PCI.
The optimal treatment of patients with STEMI and multivessel disease is of continuing interest in the era of drug-eluting stents.
STEMI patients with multivessel disease undergoing PCIs in New York between January 1, 2003, and June 30, 2006, were subdivided into those who underwent culprit vessel PCI and those who underwent multivessel PCI during the index procedure, during the index admission, or staged within 60 days of the index admission. Patients were propensity-matched and mortality rates were calculated at 12, 24, and 42 months.
A total of 3,521 patients (87.5%) underwent culprit vessel PCI during the index procedure. A total of 259 of them underwent staged PCI during the index admission and 538 patients underwent staged PCI within 60 days of the index procedure. For patients without hemodynamic compromise, culprit vessel PCI during the index procedure was associated with lower in-hospital mortality than multivessel PCI during the index procedure (0.9% vs. 2.4%, p = 0.04). Patients undergoing staged multivessel PCI within 60 days after the index procedure had a significantly lower 12-month mortality rate than patients undergoing culprit vessel PCI only (1.3% vs. 3.3%, p = 0.04).
Our findings support the American College of Cardiology/American Heart Association (ACC/AHA) recommendation that culprit vessel PCI be used for STEMI patients with multivessel disease at the time of the index PCI when patients are not hemodynamically compromised. However, staged PCI within 60 days after the index procedure, including during the index admission, is associated with risk-adjusted mortality rates that are comparable with the rate for culprit vessel PCI alone.
本研究旨在探讨 ST 段抬高型心肌梗死（STEMI）伴多支血管病变患者行单支血管（罪犯血管）经皮冠状动脉介入治疗（PCI）与多支血管 PCI 的院内和长期死亡率差异。
在药物洗脱支架时代，STEMI 伴多支血管病变患者的最佳治疗方法仍具有重要意义。
2003 年 1 月 1 日至 2006 年 6 月 30 日期间，在纽约接受 PCI 治疗的 STEMI 伴多支血管病变患者被分为罪犯血管 PCI 组和在指数治疗期间、指数住院期间或 60 天内分期进行多支血管 PCI 组。对患者进行倾向匹配，并计算 12、24 和 42 个月时的死亡率。
共有 3521 例（87.5%）患者在指数治疗期间行罪犯血管 PCI。其中 259 例行指数住院期间分期 PCI，538 例行指数治疗后 60 天内分期 PCI。对于无血流动力学障碍的患者，指数治疗期间行罪犯血管 PCI 的院内死亡率低于同期多支血管 PCI（0.9%比 2.4%，p=0.04）。在指数治疗后 60 天内行分期多支血管 PCI 的患者，12 个月死亡率明显低于仅行罪犯血管 PCI 的患者（1.3%比 3.3%，p=0.04）。
我们的研究结果支持美国心脏病学会/美国心脏协会（ACC/AHA）的建议，即当患者无血流动力学障碍时，对于 STEMI 伴多支血管病变患者，应在指数 PCI 时采用罪犯血管 PCI。然而，在指数治疗后 60 天内行分期 PCI，包括在指数住院期间进行，其风险调整死亡率与单独行罪犯血管 PCI相当。
