Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Germany.
Am J Cardiol. 2012 Apr 1;109(7):941-6. doi: 10.1016/j.amjcard.2011.11.020. Epub 2012 Jan 9.
The value of multivessel percutaneous coronary intervention (MV-PCI) in patients with cardiogenic shock (CS) and multivessel disease (MVD) is still unclear because randomized controlled trials are missing. Therefore, we sought to evaluate the impact of MV-PCI on in-hospital outcomes of patients with MVD presenting with CS: 336 patients with acute myocardial infarction complicated by CS and ≥70% stenoses in ≥2 major epicardial vessels were included in this analysis of the Euro Heart Survey PCI registry. Patients undergoing MV-PCI (n = 82, 24%) were compared to those with single-vessel PCI (n = 254, 76%). The rate of 3-vessel disease (60% vs 57%, p = 0.63) was similar in the 2 cohorts. Presentation with resuscitation (48 vs 46%, p = 0.76) and ST-segment elevation myocardial infarction (83 vs 87%, p = 0.31) was frequent in patients with MV-PCI and single-vessel PCI. Patients with ventilation were more likely to receive MV-PCI (30% vs 19%, p = 0.05). There was a tendency toward a higher hospital mortality in patients with MV-PCI (48.8% vs 37.4%, p = 0.07). After adjustment for confounding variables, no significant difference for in-hospital mortality (odd ratio [OR] 1.28, 95% confidence interval [CI] 0.72 to 2.28) could be observed between the 2 groups. Age (OR 1.41, 95% CI 1.13 to 1.77), 3-vessel disease (OR 1.78, 95% CI 1.04 to 3.03), ventilation (OR 3.01, 95% CI 1.59 to 5.68), and previous resuscitation (OR 2.55, 95% CI 1.48 to 4.39) were independent predictors of hospital death. In conclusion, MV-PCI is currently used in only 1/4 of patients with CS and MVD. An additional nonculprit PCI was not associated with a survival benefit in these high risk patients.
多支血管经皮冠状动脉介入治疗（MV-PCI）在伴有心源性休克（CS）和多支血管疾病（MVD）的患者中的价值尚不清楚，因为缺乏随机对照试验。因此，我们试图评估 MV-PCI 对伴有 CS 的 MVD 患者住院期间结局的影响：这项来自欧洲心脏调查 PCI 注册研究的分析纳入了 336 例急性心肌梗死合并 CS 且≥2 个主要心外膜血管≥70%狭窄的患者。将接受 MV-PCI（n=82，24%）的患者与接受单支血管 PCI（n=254，76%）的患者进行比较。两组 3 支血管疾病的发生率（60% vs 57%，p=0.63）相似。MV-PCI 组和单支血管 PCI 组患者中，复苏后就诊（48% vs 46%，p=0.76）和 ST 段抬高型心肌梗死（83% vs 87%，p=0.31）均很常见。接受通气的患者更有可能接受 MV-PCI（30% vs 19%，p=0.05）。MV-PCI 组患者的住院死亡率有升高趋势（48.8% vs 37.4%，p=0.07）。在调整混杂变量后，两组间住院死亡率无显著差异（比值比[OR]1.28，95%置信区间[CI]0.72 至 2.28）。年龄（OR 1.41，95%CI 1.13 至 1.77）、3 支血管疾病（OR 1.78，95%CI 1.04 至 3.03）、通气（OR 3.01，95%CI 1.59 至 5.68）和既往复苏（OR 2.55，95%CI 1.48 至 4.39）是住院死亡的独立预测因素。总之，MV-PCI 在伴有 CS 和 MVD 的患者中仅使用于 1/4 的患者。在这些高危患者中，非罪犯血管 PCI 并不能带来生存获益。
