Moretti Claudio, D'Ascenzo Fabrizio, Quadri Giorgio, Omedè Pierluigi, Montefusco Antonio, Taha Salma, Cerrato Enrico, Colaci Chiara, Chen Shao-Liang, Biondi-Zoccai Giuseppe, Gaita Fiorenzo
Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, University of Turin, Italy.
Int J Cardiol. 2015 Jan 20;179:552-7. doi: 10.1016/j.ijcard.2014.10.035. Epub 2014 Oct 22.
Appropriate management for patients with multivessel coronary disease presenting with ST segment Elevation Myocardial Infarction (STEMI) remains to be defined.
Medline and Cochrane Library were searched for randomized controlled trials (RCTs) or observational studies adjusted with multivariate analysis, reporting about STEMI patients with multivessel coronary disease treated with either a culprit only or complete revascularization strategy, excluding patients in cardiogenic shock. Prespecified analysis was performed according to the strategy of complete revascularization, either during the same procedure of primary percutaneous coronary intervention (PCI) or during the index hospitalization. MACE (a composite and mutually exclusive end point of death or myocardial infarction or revascularization) at follow-up of at least one year was the primary end point. 9 studies with 4686 patients compared culprit only versus complete PCI performed during the primary PCI. Rates of MACE did not differ at 90 days (OR 0.70 [0.38, 1.27], I(2)=0%) or at 1 year (1-2.5) (OR 0.70 [0.47, 1.03], I(2)=0%). No significant difference was found for the components of the primary outcome, apart from a reduction in repeated revascularization for patients undergoing complete PCI during the STEMI procedure (OR 0.62 [0.39, 0.98], I(2)=0%). 6 studies (1 RCT) with 5855 patients compared culprit only lesions versus complete PCI performed during index hospitalization. 90 day risk of MACE did not differ nor 1 year (1-2.5) MACE (OR 0.86 [0.62, 1.08], I(2)=0%), with a similar reduction in repeated revascularization (0.60 [0.40, 0.90], I(2)=0%).
Complete revascularization performed during primary PCI or index hospitalizations for patients presenting with STEMI appears safe at short term follow-up and offers a reduction in repeated revascularization at one year.
对于表现为ST段抬高型心肌梗死（STEMI）的多支冠状动脉疾病患者，合适的治疗方案仍有待确定。
检索了Medline和Cochrane图书馆，查找经多变量分析调整的随机对照试验（RCT）或观察性研究，这些研究报告了多支冠状动脉疾病的STEMI患者接受仅针对罪犯血管或完全血运重建策略治疗的情况，排除心源性休克患者。根据完全血运重建策略进行预定分析，无论是在初次经皮冠状动脉介入治疗（PCI）的同一过程中还是在首次住院期间。至少随访一年时的主要不良心血管事件（MACE，死亡、心肌梗死或血运重建的综合且相互排斥的终点）是主要终点。9项研究纳入4686例患者，比较了仅针对罪犯血管与初次PCI期间进行完全PCI的情况。90天时MACE发生率无差异（OR 0.70 [0.38, 1.27]，I² = 0%）或1年时（1 - 2.5）（OR 0.70 [0.47, 1.03]，I² = 0%）。除了STEMI手术期间接受完全PCI的患者重复血运重建减少外，主要结局的各组成部分未发现显著差异（OR 0.62 [0.39, 0.98]，I² = 0%）。6项研究（1项RCT）纳入5855例患者，比较了仅针对罪犯血管病变与首次住院期间进行完全PCI的情况。90天MACE风险无差异，1年（1 - 2.5）MACE也无差异（OR 0.86 [0.62, 1.08]，I² = 0%），重复血运重建也有类似程度的减少（0.60 [0.40, 0.90]，I² = 0%）。
对于STEMI患者，在初次PCI或首次住院期间进行完全血运重建在短期随访中似乎是安全的，并且在一年时可减少重复血运重建。
