Loh Joshua P, Kitabata Hironori, Torguson Rebecca, Satler Lowell F, Kent Kenneth M, Suddath William O, Pichard Augusto D, Lindsay Joseph, Waksman Ron
Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
Cardiovasc Revasc Med. 2013 Sep-Oct;14(5):258-63. doi: 10.1016/j.carrev.2013.05.005.
To determine whether staged percutaneous coronary intervention (PCI) within the same hospitalization as primary PCI is safe.
In ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease undergoing primary PCI, staged non-culprit vessel PCI at a separate session is recommended.
We conducted a retrospective analysis of 282 consecutive STEMI patients with multivessel disease who underwent primary PCI followed by staged PCI of the non-culprit vessel. Patients were categorized into staged PCI in the same hospitalization (n=184) and staged PCI at a separate hospitalization within 8 weeks of primary PCI (n=98).
Baseline characteristics, presentation of STEMI, and procedural characteristics were similar in both groups. Contrast amount was higher in the separate hospitalization group for both index (175 vs. 153 ml, p=0.011) and staged (144 vs. 120 ml, p=0.004) procedures. More staged left main PCI was performed in the separate hospitalization group (3.9 vs. 0.3%, p=0.008). Angiographic success of staged PCI was similar in both groups, with similar rates of vascular complications and major bleeding. Following staged PCI, in-hospital major adverse cardiac events (3.3 vs. 1.0%, p=0.43) and mortality (2.7 vs. 0%, p=0.17) were similar in both groups.
Our study supports the safety and feasibility of staged PCI within the same hospitalization as primary PCI, achieving similar procedural success and in-hospital outcomes as staged PCI at a separate hospitalization. Higher contrast amount used during primary PCI and presence of left main lesion in non-culprit vessels may influence the decision to stage the PCI at a separate hospitalization.
确定在与直接经皮冠状动脉介入治疗（PCI）同一住院期间进行分期PCI是否安全。
在接受直接PCI的多支血管病变ST段抬高型心肌梗死（STEMI）患者中，建议在单独的时段进行分期非罪犯血管PCI。
我们对282例连续的多支血管病变STEMI患者进行了回顾性分析，这些患者先接受了直接PCI，随后进行了非罪犯血管的分期PCI。患者被分为在同一住院期间进行分期PCI的组（n = 184）和在直接PCI后8周内进行分期PCI的单独住院组（n = 98）。
两组的基线特征、STEMI表现和手术特征相似。单独住院组在初次手术（175 vs. 153 ml，p = 0.011）和分期手术（144 vs. 120 ml，p = 0.004）中使用的造影剂剂量更高。单独住院组进行分期左主干PCI的比例更高（3.9% vs. 0.3%，p = 0.008）。两组分期PCI的血管造影成功率相似，血管并发症和大出血发生率也相似。分期PCI后，两组的院内主要不良心脏事件（3.3% vs. 1.0%，p = 0.43）和死亡率（2.7% vs. 0%，p = 0.17）相似。
我们的研究支持在与直接PCI同一住院期间进行分期PCI的安全性和可行性，其手术成功率和院内结局与在单独住院时进行分期PCI相似。直接PCI期间使用较高的造影剂剂量以及非罪犯血管中存在左主干病变可能会影响在单独住院时进行分期PCI的决策。
