Park Jin Sup, Cha Kwang Soo, Lee Dae Sung, Shin Donghun, Lee Hye Won, Oh Jun-Hyok, Kim Jeong Su, Choi Jung Hyun, Park Yong Hyun, Lee Han Cheol, Kim June Hong, Chun Kook-Jin, Hong Taek Jong, Jeong Myung Ho, Ahn Youngkeun, Chae Shung Chull, Kim Young Jo
Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
Department of Cardiology, Pusan National University Hospital, Busan, South Korea Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
Heart. 2015 Aug;101(15):1225-32. doi: 10.1136/heartjnl-2014-307220. Epub 2015 Apr 8.
The value of multivessel revascularisation in cardiogenic shock and multivessel disease (MVD) is still not clear. We compared outcomes following culprit vessel or multivessel revascularisation in patients with ST-elevation myocardial infarction (STEMI), cardiogenic shock and MVD.
From 16 620 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) in a nationwide, prospective, multicentre registry between January 2006 and December 2012, 510 eligible patients were selected and divided into culprit vessel revascularisation (n=386, 75.7%) and multivessel revascularisation (n=124, 24.3%) groups. The primary outcomes were inhospital mortality and all-cause death during a median 194-day follow-up. A weighted Cox regression model was constructed to determine the HRs and 95% CIs for outcomes in the two groups.
Compared with culprit vessel revascularisation, multivessel revascularisation had a significantly lower adjusted risk of inhospital mortality (9.3% vs 2.4%, HR 0.263, 95% CI 0.149 to 0.462, p<0.001) and all-cause death (13.1% vs 4.8%, HR 0.400, 95% CI 0.264 to 0.606, p<0.001), mainly because of fewer cardiac deaths (9.7% vs 4.8%, HR 0.510, 95% CI 0.329 to 0.790, p=0.002). In addition, multivessel revascularisation significantly decreased the adjusted risk of the composite endpoint of all-cause death, recurrent myocardial infarction and any revascularisation (20.3% vs 18.1%, HR 0.728, 95% CI 0.55 to 0.965, p=0.026).
This study showed that, compared with culprit vessel revascularisation, multivessel revascularisation at the time of primary PCI was associated with better outcomes in patients with STEMI with cardiogenic shock. Our results support the current guidelines regarding revascularisation in these patients.
心源休克合并多支血管病变（MVD）时多支血管血运重建的价值仍不明确。我们比较了ST段抬高型心肌梗死（STEMI）、心源休克和MVD患者罪犯血管血运重建或多支血管血运重建后的结局。
从2006年1月至2012年12月在全国范围内进行的一项前瞻性、多中心登记研究中接受直接经皮冠状动脉介入治疗（PCI）的16620例STEMI患者中，选取510例符合条件的患者，分为罪犯血管血运重建组（n = 386，75.7%）和多支血管血运重建组（n = 124，24.3%）。主要结局为住院死亡率和中位194天随访期间的全因死亡。构建加权Cox回归模型以确定两组结局的风险比（HR）和95%可信区间（CI）。
与罪犯血管血运重建相比，多支血管血运重建显著降低了住院死亡率（9.3%对2.4%，HR 0.263，95% CI 0.149至0.462，p < 0.001）和全因死亡的校正风险（13.1%对4.8%，HR 0.400，95% CI 0.264至0.606，p < 0.001），主要是因为心脏死亡较少（9.7%对4.8%，HR 0.510，95% CI 0.329至0.790，p = 0.002）。此外，多支血管血运重建显著降低了全因死亡、再发心肌梗死和任何血运重建的复合终点的校正风险（20.3%对18.1%，HR 0.728，95% CI 0.55至0.965，p = 0.026）。
本研究表明，与罪犯血管血运重建相比，直接PCI时多支血管血运重建与STEMI合并心源休克患者的更好结局相关。我们的结果支持当前关于这些患者血运重建的指南。
