Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, New York, USA.
Am J Cardiol. 2011 May 1;107(9):1300-10. doi: 10.1016/j.amjcard.2010.12.039. Epub 2011 Feb 23.
American College of Cardiology/American Heart Association guidelines for management of patients with ST-segment elevation myocardial infarction (STEMI) recommend culprit artery-only revascularization (CULPRIT) based on safety concerns during noninfarct-related artery intervention. However, the data to support this safety concern are scant. Searches were performed in PubMed/EMBASE/CENTRAL for studies evaluating multivessel revascularization versus CULPRIT in patients with STEMI and multivessel disease (MVD). A multivessel revascularization strategy had to be performed at the time of CULPRIT or during the same hospitalization. Early (≤30-day) and long-term outcomes were evaluated. Among 19 studies (23 arms) that evaluated 61,764 subjects with STEMI and MVD, multivessel revascularization was performed in a minority of patients (16%). For early outcomes, there was no significant difference for outcomes of mortality, MI, stroke, and target vessel revascularization, with a 44% decrease in risk of repeat percutaneous coronary intervention and major adverse cardiovascular events (odds ratio 0.68, 95% confidence interval 0.57 to 0.81) with multivessel revascularization compared to CULPRIT. Similarly, for long-term outcomes (follow-up 2.0 ± 1.1 years), there was no difference for outcomes of MI, target vessel revascularization, and stent thrombosis, with 33%, 43%, and 53% decreases in risk of mortality, repeat percutaneous coronary intervention, coronary artery bypass grafting, respectively, and major adverse cardiovascular events (odds ratio 0.60, 95% confidence interval 0.50 to 0.72) with multivessel revascularization compared to CULPRIT. In conclusion, in patients with STEMI and MVD, multivessel revascularization appears to be safe compared to culprit artery-only revascularization. These findings support the need for a large-scale randomized trial to evaluate revascularization strategies in patients with STEMI and MVD.
美国心脏病学会/美国心脏协会（ACC/AHA）关于 ST 段抬高型心肌梗死（STEMI）患者的管理指南建议，基于非梗死相关动脉介入期间的安全性考虑，仅对罪犯动脉进行血运重建（CULPRIT）。然而，支持这一安全性担忧的数据很少。在 PubMed/EMBASE/CENTRAL 中进行了检索，以评估在 STEMI 和多支血管疾病（MVD）患者中，多支血管血运重建与 CULPRIT 的比较。CULPRIT 时或同一住院期间必须进行多支血管血运重建策略。评估了早期（≤30 天）和长期结局。在评估 61764 例 STEMI 和 MVD 患者的 19 项研究（23 个研究臂）中，仅有少数患者（16%）进行了多支血管血运重建。对于早期结局，死亡率、心肌梗死、卒中和靶血管血运重建的结局无显著差异，多支血管血运重建的风险降低 44%，再次经皮冠状动脉介入和主要不良心血管事件的风险降低 44%（比值比 0.68，95%置信区间 0.57 至 0.81）。同样，对于长期结局（随访 2.0±1.1 年），心肌梗死、靶血管血运重建和支架血栓形成的结局无差异，死亡率、再次经皮冠状动脉介入、冠状动脉旁路移植术的风险分别降低 33%、43%和 53%，再次经皮冠状动脉介入、冠状动脉旁路移植术、主要不良心血管事件的风险降低 53%（比值比 0.60，95%置信区间 0.50 至 0.72）。总之，在 STEMI 和 MVD 患者中，与仅罪犯动脉血运重建相比，多支血管血运重建似乎是安全的。这些发现支持需要进行大规模随机试验，以评估 STEMI 和 MVD 患者的血运重建策略。
