Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Germany.
Int J Cardiol. 2013 Jul 1;166(3):596-600. doi: 10.1016/j.ijcard.2011.11.024. Epub 2011 Dec 20.
The role of adhoc multi-vessel percutaneous coronary intervention (MV-PCI) in patients with ST elevation myocardial infarction (STEMI) and non ST elevation acute coronary syndromes (NSTE-ACS) has not fully defined yet. Therefore, we sought to evaluate the impact of MV-PCI on in-hospital outcome of patients with MV disease presenting with ACS.
We evaluated 4, 457 haemodynamically stable patients with ACS and at least two major epicardial vessels with ≥70% stenosis of the contemporary Euro Heart Survey PCI registry. They were stratified into four categories: 419 STEMI and 734 NSTE-ACS patients undergoing MV-PCI and 2,118 STEMI and 1,186 NSTE-ACS patients undergoing culprit lesion (CL)-PCI only, respectively. In comparison to patients with CL-PCI hospital mortality was numerically lower among those undergoing MV-PCI for STEMI (1.4 versus 3.4%, P=0.03) and for NSTE-ACS (1.1 versus 2.1%, P=0.10). After adjustment for confounding variables no significant mortality difference was observed among patients treated with MV-PCI for STEMI (OR 0.48, 95%-CI 0.21-1.13) and for NSTE-ACS (OR 0.54, 95%-CI 0.24-1.22). However, the risk for non-fatal postprocedural myocardial infarction was markedly increased among patients undergoing MV-PCI for STEMI (8.8 versus 1.6%, P<0.0001) and for NSTE-ACS (5.3 versus 1.8%, P<0.0001).
In clinical practice MV-PCI in haemodynamically stable with ACS is used only in a minority of patients. There was no significant difference in hospital mortality between patients treated with MV- and CL-PCI, but MV-PCI was associated with a higher rate of postprocedural myocardial infarction.
在 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型急性冠脉综合征（NSTE-ACS）患者中，临时多血管经皮冠状动脉介入治疗（MV-PCI）的作用尚未完全明确。因此，我们试图评估 MV-PCI 对伴有 ACS 的 MV 疾病患者住院期间结局的影响。
我们评估了当代 Euro Heart Survey PCI 注册研究中 4457 例血流动力学稳定的 ACS 患者和至少两支存在 ≥70%狭窄的主要心外膜血管。他们分为四组：419 例 STEMI 和 734 例 NSTE-ACS 患者行 MV-PCI，2118 例 STEMI 和 1186 例 NSTE-ACS 患者仅行罪犯病变（CL）-PCI。与 CL-PCI 相比，STEMI 患者行 MV-PCI 的住院死亡率较低（1.4%比 3.4%，P=0.03），NSTE-ACS 患者行 MV-PCI 的住院死亡率也较低（1.1%比 2.1%，P=0.10）。调整混杂因素后，STEMI 患者行 MV-PCI（OR 0.48，95%-CI 0.21-1.13）和 NSTE-ACS 患者行 MV-PCI（OR 0.54，95%-CI 0.24-1.22）的死亡率无显著差异。然而，STEMI 患者行 MV-PCI 后非致命性心肌梗死的风险明显增加（8.8%比 1.6%，P<0.0001），NSTE-ACS 患者行 MV-PCI 后非致命性心肌梗死的风险也明显增加（5.3%比 1.8%，P<0.0001）。
在临床实践中，MV-PCI 仅在少数血流动力学稳定的 ACS 患者中使用。MV-PCI 和 CL-PCI 治疗的患者住院死亡率无显著差异，但 MV-PCI 与术后心肌梗死发生率较高相关。
