Oxford Heart Centre, Oxford, UK.
EuroIntervention. 2011 Dec;7(8):962-8. doi: 10.4244/EIJV7I8A152.
Performing percutaneous coronary intervention (PCI) to multiple coronary lesions during the same procedure has potential economic and social advantages. However comprehensive outcome data of real world practice in a large population is limited. We aimed to compare short- and long-term outcomes between patients with multivessel coronary artery disease who either underwent single- or multivessel PCI within the e-SELECT registry.
The e-SELECT registry combines data collected at 320 medical centres in 56 countries where patients received CYPHER Select® or CYPHER Select® Plus sirolimus-eluting stent (SES). Rates of myocardial infarction and major adverse cardiac event (MACE) (defined as any death, myocardial infarction or target lesion revascularisation) were compared between patients undergoing single-vessel versus multivessel PCI. A total of 15,147 patients who satisfied the inclusion criteria were included in the e-SELECT registry. Two thousand two hundred and seventy-eight (2,278) subjects (15%) underwent multivessel PCI and 12,869 (85%) had single-vessel PCI. The mean age was higher in the multivessel PCI group (63 vs. 62 years, p<0.001) and there was a higher prevalence of diabetes mellitus (32.4 vs. 30.0%, p=0.02). Lesions were more complex in the single-PCI group while pre- and post-dilatation were less common in the multivessel PCI group. Myocardial infarction within the first 30 days post PCI was more common in the multivessel PCI group (1.9 vs. 0.8%, p<0.001) and most of the infarctions were periprocedural (1.3 vs. 0.6%, p=0.001). Mortality and myocardial infarction at one-year were higher in the multivessel PCI group resulting in a significantly higher MACE (6.1 vs. 4.6%, p=0.005).
Overall procedural and one year outcomes were excellent for both single- and multivessel procedures. However despite lower lesion complexity, performing multivessel PCI was associated with higher rates of periprocedural myocardial infarction and MACE when compared to single-vessel PCI in the e-SELECT registry.
在同一手术过程中对多条冠状动脉病变进行经皮冠状动脉介入治疗（PCI）具有潜在的经济和社会效益。然而，目前综合的实际世界实践的结果数据在较大的人群中是有限的。我们旨在比较多支冠状动脉疾病患者中接受单支或多支 PCI 的短期和长期结局，这些患者来自 e-SELECT 注册研究。
e-SELECT 注册研究结合了在 56 个国家的 320 个医疗中心收集的数据，这些患者接受了 CYPHER Select®或 CYPHER Select®Plus 西罗莫司洗脱支架（SES）的治疗。比较了接受单支和多支 PCI 的患者之间心肌梗死和主要不良心脏事件（MACE）（定义为任何死亡、心肌梗死或靶病变血运重建）的发生率。共有 15147 名符合纳入标准的患者被纳入 e-SELECT 注册研究。2278 名（15%）患者接受了多支 PCI，12869 名（85%）患者接受了单支 PCI。多支 PCI 组的平均年龄更高（63 岁 vs. 62 岁，p<0.001），糖尿病的患病率更高（32.4% vs. 30.0%，p=0.02）。单支 PCI 组的病变更复杂，而多支 PCI 组中预扩张和后扩张的比例较低。多支 PCI 组 PCI 术后 30 天内心肌梗死更常见（1.9% vs. 0.8%，p<0.001），且大多数梗死为围手术期（1.3% vs. 0.6%，p=0.001）。多支 PCI 组的 1 年死亡率和心肌梗死发生率更高，导致 MACE 发生率显著升高（6.1% vs. 4.6%，p=0.005）。
单支和多支手术的总体手术过程和 1 年结果都非常好。然而，与单支 PCI 相比，尽管病变复杂性较低，但在 e-SELECT 注册研究中，多支 PCI 与围手术期心肌梗死和 MACE 的发生率较高相关。
