Cardiology, University Hospital, Basel, Switzerland.
University Heart Center, University Hospital Zurich, Switzerland.
Int J Cardiol. 2014 Mar 1;172(1):76-81. doi: 10.1016/j.ijcard.2013.12.083. Epub 2014 Jan 4.
The optimal strategy for percutaneous coronary intervention (PCI) of ST-segment elevation myocardial infarction (STEMI) in multi-vessel disease (MVD), i.e., multi-vessel PCI (MV-PCI) vs. PCI of the infarct-related artery only (IRA-PCI), still remains unknown.
Patients of the AMIS Plus registry admitted with an acute coronary syndrome were contacted after a median of 378 days (interquartile range 371-409). The primary end-point was all-cause death. The secondary end-point included all major adverse cardiovascular and cerebrovascular events (MACCE) including death, re-infarction, re-hospitalization for cardiac causes, any cardiac re-intervention, and stroke.
Between 2005 and 2012, 8330 STEMI patients were identified, of whom 1909 (24%) had MVD. Of these, 442 (23%) received MV-PCI and 1467 (77%) IRA-PCI. While all-cause mortality was similar in both groups (2.7% both, p>0.99), MACCE was significantly lower after MV-PCI vs. IRA-PCI (15.6% vs. 20.0%, p=0.038), mainly driven by lower rates of cardiac re-hospitalization and cardiac re-intervention. Patients undergoing MV-PCI with drug-eluting stents had lower rates of all-cause mortality (2.1% vs. 7.4%, p=0.026) and MACCE (14.1% vs. 25.9%, p=0.042) compared with those receiving bare metal stents (BMS). In multivariate analysis, MV-PCI (odds ratio, OR 0.69, 95% CI 0.51-0.93, p=0.017) and comorbidities (Charlson index ≥ 2; OR 1.42, 95% CI 1.05-1.92, p=0.025) were independent predictors for 1-year MACCE.
In an unselected nationwide real-world cohort, an approach using immediate complete revascularization may be beneficial in STEMI patients with MVD regarding MACCE, specifically when drug-eluting stents are used, but not regarding mortality. This has to be tested in a randomized controlled trial.
多血管病变（MVD）患者行经皮冠状动脉介入治疗（PCI）治疗ST 段抬高型心肌梗死（STEMI）时，最佳策略是多血管 PCI（MV-PCI）还是仅梗死相关动脉 PCI（IRA-PCI）仍不清楚。
登记注册的 AMIS Plus 研究在中位时间 378 天后（四分位距 371-409）联系急性冠脉综合征患者。主要终点是全因死亡。次要终点包括所有主要不良心血管和脑血管事件（MACCE），包括死亡、再梗死、因心脏原因再次住院、任何心脏再介入治疗和卒中。
2005 年至 2012 年，共确定 8330 例 STEMI 患者，其中 1909 例（24%）有 MVD。其中，442 例（23%）接受 MV-PCI，1467 例（77%）接受 IRA-PCI。虽然两组全因死亡率相似（均为 2.7%，p＞0.99），但 MV-PCI 组的 MACCE 明显低于 IRA-PCI 组（15.6% vs. 20.0%，p=0.038），主要原因是心脏再住院和心脏再介入治疗的发生率较低。与接受金属裸支架（BMS）的患者相比，接受药物洗脱支架的患者行 MV-PCI 的全因死亡率（2.1% vs. 7.4%，p=0.026）和 MACCE（14.1% vs. 25.9%，p=0.042）较低。多变量分析显示，MV-PCI（比值比，OR 0.69，95%可信区间 0.51-0.93，p=0.017）和合并症（Charlson 指数≥2；OR 1.42，95%可信区间 1.05-1.92，p=0.025）是 1 年 MACCE 的独立预测因素。
在未选择的全国真实世界队列中，对于 MVD 的 STEMI 患者，采用即刻完全血运重建的方法可能有利于 MACCE，特别是当使用药物洗脱支架时，但对死亡率没有影响。这需要在随机对照试验中进行检验。
