Chonnam National University Hospital, South Korea.
Int J Cardiol. 2011 Dec 1;153(2):148-53. doi: 10.1016/j.ijcard.2010.08.044. Epub 2010 Sep 16.
In patients with non-ST-elevation myocardial infarction (NSTEMI), current guidelines did not recommend optimal revascularization management in multivessel coronary artery disease. We compared clinical outcomes between multivessel revascularization and culprit-only revascularization in this setting.
A total of 1919 patients with multivessel disease (1011 patients; multivessel revascularization group, 908 patients; culprit-only revascularization group) diagnosed as NSTEMI was enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008. The primary end-points were major adverse cardiac events (MACE), all-causes of deaths, myocardial infarction (MI), and repeated percutaneous coronary intervention (PCI) during 1-year clinical follow-up. Also, subgroup analysis was performed in patients with high TIMI (Thrombolysis In Myocardial Infarction) risk score (≥ 4) to find efficacy of multivessel PCI in high-risk patients.
Baseline clinical characteristics and the risk factors of coronary artery disease were similar between both groups. In angiography, three-vessel lesion was more presented in the multivessel group (46.1% vs. 40.9%, p = 0.024) and rates of left anterior descending and left main stem coronary artery as culprit vessel were higher in the multivessel group (p = 0.003 and p = 0.001 respectively). In-hospital mortality was higher in the culprit-only group (1.4% vs. 2.9%, p = 0.025). Primary end-points occurred in 241 patients (15.5%) during 1-year follow-up. Multivessel revascularization reduced MACEs [hazard ratio (HR) 0.658, 95% confidence interval (CI) 0.45 to 0.96, p = 0.031], death or myocardial infarction (HR 0.58, 95% CI 0.35 to 0.97, p = 0.037) and non-target vessel revascularization (HR 0.44, 95% CI 0.24 to 0.81, p = 0.008). There were no significant differences in target lesion revascularization (TLR; HR 1.38, 95% CI 0.51 to 3.71, p = 0.529) and target vessel revascularization (TVR; HR 0.28, 95% CI 0.05 to 1.47, p = 0.131). In subgroup analysis in patients with a higher TIMI risk score, similar results were presented.
Multivessel revascularization in multivessel coronary artery disease presenting with NSTEMI showed better clinical outcomes without significant in-stent restenosis and progression of diseased-vessel compared to culprit-only revascularization.
在非 ST 段抬高型心肌梗死（NSTEMI）患者中，现行指南并未推荐对多支血管冠状动脉疾病进行最佳血运重建管理。我们比较了在此情况下多支血管血运重建与罪犯血管血运重建的临床结局。
共有 1919 名多支血管疾病（1011 名患者；多支血管血运重建组 908 名患者；罪犯血管血运重建组）的患者被纳入 2005 年 11 月至 2008 年 1 月进行的全国前瞻性韩国急性心肌梗死注册研究（KAMIR）。主要终点为主要不良心脏事件（MACE）、全因死亡、心肌梗死（MI）和 1 年临床随访期间重复经皮冠状动脉介入治疗（PCI）。还对 TIMI 高风险评分（≥4）的患者进行了亚组分析，以确定多支血管 PCI 在高危患者中的疗效。
两组患者的基线临床特征和冠心病危险因素相似。在血管造影中，多支血管组的三支血管病变更为常见（46.1% vs. 40.9%，p=0.024），左前降支和左主干冠状动脉作为罪犯血管的比例也更高（p=0.003 和 p=0.001）。罪犯血管血运重建组的院内死亡率更高（1.4% vs. 2.9%，p=0.025）。1 年随访期间有 241 名患者（15.5%）发生主要终点事件。多支血管血运重建降低了 MACE（风险比 [HR] 0.658，95%置信区间 [CI] 0.45 至 0.96，p=0.031）、死亡或心肌梗死（HR 0.58，95%CI 0.35 至 0.97，p=0.037）和非靶血管血运重建（HR 0.44，95%CI 0.24 至 0.81，p=0.008）。靶病变血运重建（TLR；HR 1.38，95%CI 0.51 至 3.71，p=0.529）和靶血管血运重建（TVR；HR 0.28，95%CI 0.05 至 1.47，p=0.131）差异无统计学意义。在 TIMI 风险评分较高的患者亚组分析中，也得到了类似的结果。
在伴有 NSTEMI 的多支血管冠状动脉疾病患者中，多支血管血运重建与罪犯血管血运重建相比，可改善临床结局，且支架内再狭窄和病变血管进展不明显。
