Interventional Cardiology Unit, A.O. Ordine Mauriziano Umberto I, Turin, Italy.
J Interv Cardiol. 2011 Dec;24(6):535-41. doi: 10.1111/j.1540-8183.2011.00666.x. Epub 2011 Oct 20.
Optimal management of multivessel disease (MVD) in ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PCI) is still unclear.
To compare short- and long-term clinical outcomes of early-staged, angio-guided approach and delayed, ischemia-guided treatment of non-infarct-related arteries (IRAs).
Consecutive patients with STEMI and MVD treated with primary PCI in 6 tertiary care centers were retrospectively selected and analyzed. Major adverse cardiac events (MACE) were defined as the composite end-point of death, MI, and repeat revascularization. All the events were adjudicated according to the Academic Research Consortium (ARC) definitions.
In the time period 2004-2008, 800 primary PCIs in STEMI patients with MVD were performed. Four hundred and seventeen were addressed to early-staged, angio-guided PCI of non-IRAs (CR group) and 383 to an incomplete revascularization (IncR group). During the hospital stay, no difference in terms of death and repeat revascularization was found between groups but the incidence of periprocedural MI/reinfarction and MACE was significantly higher in the CR group (13.9% vs. 3.1%, P = 0.01 and 14.1% vs. 9.1%, P = 0.017, respectively). At a mean follow-up of 642 ± 545 days, no difference in terms of death and MI was found between the CR and IncR group. The MACE-free survival was significantly higher in the IncR group (73.8% vs. 57%, log rank 0.05), mainly driven by the lower incidence of re-PCI.
Early complete revascularization based only on angiographic findings in patients with STEMI and MVD is associated with an excess of periprocedural/re-MI and with a significantly higher incidence of MACE at follow-up.
在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中，多支血管病变（MVD）的最佳治疗方法仍不明确。
比较早期血管造影指导下治疗非梗死相关动脉（IRA）与延迟缺血指导下治疗非梗死相关动脉的短期和长期临床结果。
回顾性分析了在 6 家三级护理中心接受直接 PCI 治疗的 STEMI 合并 MVD 的连续患者。主要不良心脏事件（MACE）定义为死亡、心肌梗死和再次血运重建的复合终点。所有事件均根据学术研究联合会（ARC）的定义进行裁决。
在 2004 年至 2008 年期间，对 800 例 STEMI 合并 MVD 患者进行了 800 例直接 PCI。其中 417 例接受早期血管造影指导下的非 IRA 直接 PCI（CR 组），383 例接受不完全血运重建（IncR 组）。住院期间，两组间在死亡和再次血运重建方面无差异，但 CR 组围手术期心肌梗死/再梗死和 MACE 的发生率显著较高（13.9%比 3.1%，P=0.01 和 14.1%比 9.1%，P=0.017）。平均随访 642±545 天后，CR 组和 IncR 组在死亡和心肌梗死方面无差异。IncR 组的 MACE 无事件生存率显著较高（73.8%比 57%，对数秩检验 P=0.05），主要原因是再次 PCI 的发生率较低。
在 STEMI 和 MVD 患者中，仅根据血管造影结果进行早期完全血运重建与围手术期/再发心肌梗死的发生率增加有关，并与随访时更高的 MACE 发生率相关。
