Division of Cardiology, University of Turin, Turin, Italy.
Am Heart J. 2010 Dec;160(6 Suppl):S28-35. doi: 10.1016/j.ahj.2010.10.013.
Primary percutaneous coronary intervention of the infarct-related artery is now considered the gold standard for patients with acute ST-elevation myocardial infarction. However, a sizable portion of patients with ST-elevation myocardial infarction have concomitant multivessel disease, which raises important therapeutic and prognostic issues. Indeed, it is still unclear whether percutaneous coronary intervention of the culprit vessel alone is superior, equivalent, or inferior in terms of risk-benefit balance in comparison to a strategy of complete revascularization, with percutaneous coronary intervention of nonculprit vessels as well. The present systematic review provides an updated prospective on the rationale, background, and outcomes of culprit-only versus multivessel percutaneous revascularization in subjects undergoing primary percutaneous coronary intervention. Our findings clearly demonstrate that multivessel coronary disease significantly and adversely impacts on patient prognosis, yet a culprit-only revascularization strategy should be sought after in most cases, unless patient instability or symptoms/signs of residual myocardial ischemia support nonculprit vessel intervention.
对于急性 ST 段抬高型心肌梗死患者，直接经皮冠状动脉介入治疗（primary percutaneous coronary intervention，pPCI）目前被认为是金标准。然而，相当一部分 ST 段抬高型心肌梗死患者存在多支血管病变，这引发了重要的治疗和预后问题。实际上，单独经皮冠状动脉介入治疗罪犯血管在风险-获益平衡方面是否优于、等效于或劣于包括非罪犯血管在内的完全血运重建策略，目前仍不清楚。本系统综述提供了一个关于在接受直接经皮冠状动脉介入治疗的患者中，单纯罪犯血管血运重建与多血管血运重建的基本原理、背景和结局的最新前瞻性观点。我们的研究结果清楚地表明，多支冠状动脉疾病显著且不利地影响患者的预后，但在大多数情况下，应寻求单纯罪犯血管血运重建策略，除非患者不稳定或存在残余心肌缺血的症状/体征，支持非罪犯血管介入。
