Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
EuroIntervention. 2013 Dec;9(8):909-15. doi: 10.4244/EIJV9I8A153.
We examined what type of STEMI patients are more likely to undergo multivessel PCI (MPCI) in a "real-world" setting and whether MPCI leads to worse or better outcomes compared with single-vessel PCI (SPCI) after stratifying patients by risk.
Among STEMI patients enrolled in the Swiss AMIS Plus registry between 2005 and 2012 (n=12,000), 4,941 were identified with multivessel disease. We then stratified patients based on MPCI use and their risk. High-risk patients were identified a priori as those with: 1) left main (LM) involvement (lesions, n=263); 2) out-of-hospital cardiac arrest; or 3) Killip class III/IV. Logistic regression models examined for predictors of MPCI use and the association between MPCI and in-hospital mortality. Three thousand eight hundred and thirty-three (77.6%) patients underwent SPCI and 1,108 (22.4%) underwent MPCI. Rates of MPCI were greater among high-risk patients for each of the three categories: 8.6% vs. 5.9% for out-of-hospital cardiac arrest (p<0.01); 12.3% vs. 6.2% for Killip III/IV (p<0.001); and 14.5% vs. 2.7% for LM involvement (p<0.001). Overall, in-hospital mortality after MPCI was higher when compared with SPCI (7.3% vs. 4.4%; p<0.001). However, this result was not present when patients were stratified by risk: in-hospital mortality for MPCI vs. SPCI was 2.0% vs. 2.0% (p=1.00) in low-risk patients and 22.2% vs. 21.7% (p=1.00) in high-risk patients.
High-risk patients are more likely to undergo MPCI. Furthermore, MPCI does not appear to be associated with higher mortality after stratifying patients based on their risk.
本研究旨在探讨在“真实世界”环境下哪些 STEMI 患者更有可能接受多支血管经皮冠状动脉介入治疗（MPCI），以及在对患者进行风险分层后，与单支血管经皮冠状动脉介入治疗（SPCI）相比，MPCI 是否会导致更差或更好的结果。
在 2005 年至 2012 年间纳入瑞士 AMIS Plus 注册研究的 STEMI 患者中（n=12000），有 4941 例患者被确定为多支血管病变。然后，我们根据 MPCI 的使用情况和患者的风险对患者进行分层。高风险患者被预先定义为：1）左主干（LM）受累（病变，n=263）；2）院外心脏骤停；或 3）Killip 分级 III/IV 级。Logistic 回归模型用于检查 MPCI 使用的预测因素以及 MPCI 与住院死亡率之间的关联。3833 例（77.6%）患者接受了 SPCI，1108 例（22.4%）患者接受了 MPCI。对于每一类患者，高风险患者中 MPCI 的比例更高：院外心脏骤停患者中为 8.6% vs. 5.9%（p<0.01）；Killip III/IV 级患者中为 12.3% vs. 6.2%（p<0.001）；LM 受累患者中为 14.5% vs. 2.7%（p<0.001）。总体而言，与 SPCI 相比，MPCI 后住院死亡率更高（7.3% vs. 4.4%；p<0.001）。然而，当根据风险对患者进行分层时，结果并非如此：低风险患者中 MPCI 与 SPCI 的住院死亡率分别为 2.0% vs. 2.0%（p=1.00），高风险患者中分别为 22.2% vs. 21.7%（p=1.00）。
高风险患者更有可能接受 MPCI。此外，在根据患者风险分层后，MPCI 似乎与死亡率升高无关。
