Cavender Matthew A, Rajeswaran Jeevanantham, DiPaola Linda, Houghtaling Penny, Kiernan Michael S, Rassi Andrew N, Menon Venu, Whitlow Patrick W, Ellis Stephen G, Shishehbor Mehdi H
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Invasive Cardiol. 2013 May;25(5):218-24.
The optimal revascularization strategy in patients with multivessel coronary artery disease (MVCAD) who present with ST-elevation myocardial infarction (STEMI) and shock is undefined. We aimed to determine differences in survival among patients with MVCAD presenting with STEMI complicated by shock treated with percutaneous coronary intervention (PCI) of the infarct-related artery alone (culprit-only PCI) versus multivessel PCI (MVPCI).
Patients with MVCAD and STEMI complicated by shock who underwent PCI between January 1, 2002 and May 31, 2010 were identified (n = 199). Differences in survival between patients undergoing culprit-only PCI versus MVPCI were assessed using a multiphase survival model and propensity matching.
MVPCI was used in 22% of patients (n = 43). Patient characteristics were similar in the groups, although more patients treated with MVPCI met the National Cardiovascular Data Registry definition of shock. Death was higher in patients treated with MVPCI at 1 month (27% vs 46%) and 8 years (65% vs 75%; P=.04). The early risk of death was higher in the patients treated with MVPCI when compared to patients treated with culprit-only PCI (coefficient: 0.66 ± 0.25; P=.009), but not the late risk of death (coefficient: -0.18 ± 0.58; P=.70). However, in a propensity-matched cohort (n = 64), there were no differences in the risk of death over the early (coefficient: 0.50 ± 0.37; P=.16) or late phase (P>.90).
Patients undergoing MVPCI for STEMI-related shock are clinically different than those treated with culprit PCI only; however, after risk adjustment both groups have similar short- and long-term outcomes. Prospective studies are needed to determine the optimal revascularization strategy in this high-risk population.
对于患有多支冠状动脉疾病（MVCAD）且出现ST段抬高型心肌梗死（STEMI）并伴有休克的患者，最佳的血运重建策略尚不明确。我们旨在确定仅对梗死相关动脉进行经皮冠状动脉介入治疗（PCI）（仅罪犯血管PCI）与多支血管PCI（MVPCI）治疗的STEMI合并休克的MVCAD患者之间的生存差异。
确定2002年1月1日至2010年5月31日期间接受PCI治疗的MVCAD和STEMI合并休克患者（n = 199）。使用多阶段生存模型和倾向匹配评估仅罪犯血管PCI与MVPCI患者之间的生存差异。
22%的患者（n = 43）接受了MVPCI。两组患者的特征相似，尽管接受MVPCI治疗的患者更多符合国家心血管数据注册中心对休克的定义。MVPCI治疗的患者在1个月时死亡率较高（27%对46%），8年时死亡率也较高（65%对75%；P = 0.04）。与仅罪犯血管PCI治疗的患者相比，MVPCI治疗的患者早期死亡风险更高（系数：0.66±0.25；P = 0.009），但晚期死亡风险无差异（系数：-0.18±0.58；P = 0.70）。然而，在倾向匹配队列（n = 64）中，早期（系数：0.50±0.37；P = 0.16）或晚期（P>0.90）死亡风险无差异。
因STEMI相关休克接受MVPCI治疗的患者与仅接受罪犯血管PCI治疗的患者在临床上有所不同；然而，经过风险调整后，两组的短期和长期结局相似。需要进行前瞻性研究以确定这一高危人群的最佳血运重建策略。
