Tarasov R S
Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia.
Angiol Sosud Khir. 2016;22(2):127-32.
The study was aimed at analysing the outcomes of multivessel revascularization by means of percutaneous coronary intervention (PCI) in a total of 190 patients presenting with ST segment elevation myocardial infarction (STEMI) and multivessel lesion (MVL) of coronary arteries. Patients with unsuccessful PCI or those having received no planned second stage of revascularization for any reason were excluded from the study. The patients were subdivided into two groups: Group One comprised those having received appropriate complete revascularization (CR) within the framework of multivessel stenting (MVS) during primary PCI or a stagewise approach (n=137), Group Two included patients with the so-called appropriate incomplete revascularization (AIR) after MVS or stagewise PCI (n=53). In all cases IR was considered appropriate due to the presence of the corresponding anatomical and/or functional criteria used in the literature but not studied in relation to the cohort of patients with STEMI: (1) small arterial diameter (<2.5 mm), (2) not more than one epicardial vessel left without revascularization, (3) stenoses in second-order branches in a minimally symptomatic course of the disease, (4) nonviable myocardium or small volume of the viable myocardium in the area of blood supply of the artery. The carried out analysis of the incidence rate of adverse cardiovascular events during 12 months of follow up showed no significant differences between the studied groups. A conclusion was made that criteria of AIR may effectively be implemented also in the cohort of patients with STEMI, which would promote optimization of therapeutic results in such patients, decreasing the risk of complications associated with unsubstantiated PCI.
该研究旨在分析190例患有ST段抬高型心肌梗死(STEMI)和冠状动脉多支病变(MVL)的患者经皮冠状动脉介入治疗(PCI)进行多支血管血运重建的结果。PCI未成功或因任何原因未接受计划中的第二阶段血运重建的患者被排除在研究之外。患者被分为两组:第一组包括在初次PCI或分期治疗过程中,在多支血管支架置入术(MVS)框架内接受了适当完全血运重建(CR)的患者(n = 137),第二组包括在MVS或分期PCI后出现所谓适当不完全血运重建(AIR)的患者(n = 53)。在所有情况下,由于存在文献中使用的相应解剖学和/或功能标准,但未针对STEMI患者队列进行研究,IR被认为是适当的:(1)动脉直径小(<2.5 mm),(2)未进行血运重建的心外膜血管不超过一支,(3)疾病症状轻微过程中的二级分支狭窄,(4)动脉供血区域的心肌无活力或存活心肌体积小。对随访12个月期间不良心血管事件发生率的分析表明,研究组之间无显著差异。得出的结论是,AIR标准也可有效地应用于STEMI患者队列,这将促进此类患者治疗结果的优化,降低与不必要的PCI相关的并发症风险。