Mangion Kenneth, Carrick David, Hennigan Barry W, Payne Alexander R, McClure John, Mason Maureen, Das Rajiv, Wilson Rebecca, Edwards Richard J, Petrie Mark C, McEntegart Margaret, Eteiba Hany, Oldroyd Keith G, Berry Colin
BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK.
Heart. 2016 Dec 15;102(24):1980-1987. doi: 10.1136/heartjnl-2015-308660. Epub 2016 Aug 8.
We hypothesised that, compared with culprit-only primary percutaneous coronary intervention (PCI), additional preventive PCI in selected patients with ST-elevation myocardial infarction with multivessel disease would not be associated with iatrogenic myocardial infarction, and would be associated with reductions in left ventricular (LV) volumes in the longer term.
In the preventive angioplasty in myocardial infarction trial (PRAMI; ISRCTN73028481), cardiac magnetic resonance (CMR) was prespecified in two centres and performed (median, IQR) 3 (1, 5) and 209 (189, 957) days after primary PCI.
From 219 enrolled patients in two sites, 84% underwent CMR. 42 (50%) were randomised to culprit-artery-only PCI and 42 (50%) were randomised to preventive PCI. Follow-up CMR scans were available in 72 (86%) patients. There were two (4.8%) cases of procedure-related myocardial infarction in the preventive PCI group. The culprit-artery-only group had a higher proportion of anterior myocardial infarctions (MIs) (55% vs 24%). Infarct sizes (% LV mass) at baseline and follow-up were similar. At follow-up, there was no difference in LV ejection fraction (%, median (IQR), (culprit-artery-only PCI vs preventive PCI) 51.7 (42.9, 60.2) vs 54.4 (49.3, 62.8), p=0.23), LV end-diastolic volume (mL/m, 69.3 (59.4, 79.9) vs 66.1 (54.7, 73.7), p=0.48) and LV end-systolic volume (mL/m, 31.8 (24.4, 43.0) vs 30.7 (23.0, 36.3), p=0.20). Non-culprit angiographic lesions had low-risk Syntax scores and 47% had non-complex characteristics.
Compared with culprit-only PCI, non-infarct-artery MI in the preventive PCI strategy was uncommon and LV volumes and ejection fraction were similar.
我们假设，与仅对罪犯血管进行的直接经皮冠状动脉介入治疗（PCI）相比，在部分患有多支血管病变的ST段抬高型心肌梗死患者中进行额外的预防性PCI不会导致医源性心肌梗死，且从长远来看会使左心室（LV）容积减小。
在心肌梗死预防性血管成形术试验（PRAMI；ISRCTN73028481）中，两个中心预先规定进行心脏磁共振成像（CMR）检查，并在直接PCI术后3（1，5）天和209（189，957）天进行（中位数，四分位间距）。
在两个研究地点入组的219例患者中，84%接受了CMR检查。42例（50%）被随机分配至仅对罪犯血管进行PCI组，42例（50%）被随机分配至预防性PCI组。72例（86%）患者有随访期CMR扫描结果。预防性PCI组有2例（4.8%）发生与手术相关的心肌梗死。仅对罪犯血管进行PCI组前壁心肌梗死（MI）的比例更高（55%对24%）。基线期和随访期的梗死面积（占LV质量的百分比）相似。随访时，左心室射血分数（%，中位数（四分位间距），仅对罪犯血管进行PCI组对预防性PCI组）51.7（42.9，60.2）对54.4（49.3，62.8），p = 0.23）、左心室舒张末期容积（mL/m，69.3（59.4，79.9）对66.1（54.7，73.7），p = 0.48）和左心室收缩末期容积（mL/m，31.8（24.4，43.0）对30.7（23.0，36.3），p = 0.20）均无差异。非罪犯血管造影病变的Syntax评分低风险，47%具有非复杂性特征。
与仅对罪犯血管进行PCI相比，预防性PCI策略中非梗死血管发生心肌梗死的情况不常见，且左心室容积和射血分数相似。
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