Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, Box 1030, New York, New York 10029, USA.
Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
Nat Rev Cardiol. 2017 Nov;14(11):665-678. doi: 10.1038/nrcardio.2017.88. Epub 2017 Jun 29.
Approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel disease. The optimal reperfusion strategy in these patients is still uncertain. Whether percutaneous coronary intervention (PCI) of only the culprit vessel or a strategy of complete revascularization, either in a simultaneous or staged multivessel PCI approach, should be performed remains unclear. Although a large number of observational studies have mostly shown worse clinical outcomes associated with a multivessel PCI approach, increasing evidence from randomized controlled trials suggests that multivessel PCI is safe, while reducing the need for revascularization in selected patients, compared with culprit vessel-only PCI. However, adequately-powered studies are still needed to determine the best treatment strategy in patients with STEMI and multivessel disease, particularly to demonstrate a reduction in the hard end point of death or myocardial infarction. In this Review, we provide a comprehensive summary of current evidence on the different treatment options for patients with STEMI and multivessel disease, highlighting current guideline recommendations and providing future directions on reperfusion strategies in these patients.
约 50%的 ST 段抬高型心肌梗死（STEMI）患者存在多支血管病变。这些患者的最佳再灌注策略仍不确定。对于这些患者，究竟应选择仅罪犯血管经皮冠状动脉介入治疗（PCI），还是应选择完全血运重建策略，包括同时或分期进行多支血管 PCI，目前仍不明确。虽然大量观察性研究主要表明多支血管 PCI 策略与更差的临床结局相关，但越来越多的随机对照试验证据表明，与仅罪犯血管 PCI 相比，多支血管 PCI 是安全的，同时可减少某些患者的血运重建需求。然而，仍需要进行充分的研究来确定 STEMI 合并多支血管病变患者的最佳治疗策略，特别是需要证明可降低死亡或心肌梗死这一硬终点事件的发生率。在本综述中，我们全面总结了 STEMI 合并多支血管病变患者的不同治疗选择的现有证据，重点介绍了当前的指南推荐，并为这些患者的再灌注策略提供了未来的方向。
