Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, and Hôpital Claude Galien, Quincy, France.
JACC Cardiovasc Interv. 2013 Feb;6(2):115-25. doi: 10.1016/j.jcin.2012.10.006. Epub 2013 Jan 23.
This study sought to assess the impact of multivessel (MV) primary percutaneous coronary intervention (PCI) on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) presenting with cardiogenic shock (CS) and resuscitated cardiac arrest (CA).
The safety and efficacy of MV primary PCI in patients with STEMI and refractory CS is unknown.
We conducted a multicenter prospective observational study of consecutive STEMI patients presenting to 5 French centers. Patients were classified as having single-vessel (SVD) or multivessel (MVD) coronary disease, and underwent culprit-only or MV primary PCI. Baseline characteristics and 6-month survival were compared.
Among 11,530 STEMI patients, 266 had resuscitated CA and CS. Patients with SVD (36.5%) had increased 6-month survival compared to those with MVD (29.6% vs. 42.3%, p = 0.032). Baseline characteristics were similar in those with MVD undergoing culprit-only (60.9%) or MV (39.1%) primary PCI. However, 6-month survival was significantly greater in patients who underwent MV PCI (43.9% vs. 20.4%, p = 0.0017). This survival advantage was mediated by a reduction in the composite of recurrent CA and death due to shock (p = 0.024) in MV PCI patients. In those with MVD, culprit artery PCI success (hazard ratio [HR]: 0.63; 95% confidence interval [CI]: 0.41 to 0.96, p = 0.030) and MV primary PCI (HR: 0.57; 95% CI: 0.38 to 0.84, p = 0.005) were associated with increased 6-month survival.
The results of this study suggest that in STEMI patients with MVD presenting with CS and CA, MV primary PCI may improve clinical outcome. Randomized trials are required to verify these results.
本研究旨在评估多支血管（MV）直接经皮冠状动脉介入治疗（PCI）对伴心源性休克（CS）和复苏性心脏骤停（CA）的 ST 段抬高型心肌梗死（STEMI）患者临床结局的影响。
MV 直接 PCI 治疗 STEMI 合并难治性 CS 的安全性和有效性尚不清楚。
我们进行了一项多中心前瞻性观察性研究，纳入了 5 家法国中心连续收治的 STEMI 患者。患者分为单支血管（SVD）或多支血管（MVD）病变，并接受罪犯血管或 MV 直接 PCI。比较基线特征和 6 个月生存率。
在 11530 例 STEMI 患者中，有 266 例发生复苏性 CA 和 CS。SVD 患者（36.5%）的 6 个月生存率高于 MVD 患者（29.6% vs. 42.3%，p = 0.032）。MVD 患者中，仅罪犯血管（60.9%）或 MV（39.1%）直接 PCI 的基线特征相似。然而，MV PCI 患者的 6 个月生存率显著更高（43.9% vs. 20.4%，p = 0.0017）。MV PCI 患者的主要复合终点（再发 CA 和因休克导致的死亡）发生率降低，这是导致生存率差异的原因（p = 0.024）。在 MVD 患者中，罪犯动脉 PCI 成功（风险比[HR]：0.63；95%置信区间[CI]：0.41 至 0.96，p = 0.030）和 MV 直接 PCI（HR：0.57；95%CI：0.38 至 0.84，p = 0.005）与 6 个月生存率增加相关。
本研究结果表明，在伴 CS 和 CA 的 MVD STEMI 患者中，MV 直接 PCI 可能改善临床结局。需要随机试验来验证这些结果。
