Thomas Michael P, Bates Eric R
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
Curr Opin Cardiol. 2017 Nov;32(6):755-760. doi: 10.1097/HCO.0000000000000446.
This review aims to summarize recent reports on percutaneous coronary intervention (PCI) strategies for patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD).
Recent randomized clinical trials and meta-analyses have suggested that patients with STEMI and multivessel CAD may benefit more from multivessel PCI (either multivessel primary PCI or staged PCI before hospital discharge) than culprit vessel-only primary PCI. These reports have changed clinical practice guideline recommendations that now conclude that multivessel PCI may be considered in selected hemodynamically stable patients with significant noninfarct artery stenoses based on anatomic criteria alone. Fractional flow reserve measurement can document functional significance in nonculprit stenoses, but fractional flow reserve-guided PCI has not been shown to impact mortality or myocardial infarction rates. Additionally, nonculprit artery chronic total occlusion PCI was not effective in improving left ventricular function in one randomized trial.
Multivessel primary PCI or staged PCI is effective and safe in selected patients with STEMI and multivessel coronary disease. Future randomized controlled trials are needed to define the optimal timing of multivessel PCI, as well as the appropriate use of PCI in nonculprit stenoses.
本综述旨在总结近期关于ST段抬高型心肌梗死（STEMI）合并多支冠状动脉疾病（CAD）患者经皮冠状动脉介入治疗（PCI）策略的报告。
近期的随机临床试验和荟萃分析表明，STEMI合并多支CAD患者接受多支血管PCI（多支血管直接PCI或出院前分期PCI）可能比仅对罪犯血管进行直接PCI获益更多。这些报告改变了临床实践指南的建议，现在得出结论，对于某些血流动力学稳定、仅根据解剖学标准存在明显非梗死动脉狭窄的患者，可考虑进行多支血管PCI。血流储备分数测量可记录非罪犯狭窄的功能意义，但血流储备分数指导的PCI尚未显示对死亡率或心肌梗死发生率有影响。此外，在一项随机试验中，非罪犯动脉慢性完全闭塞PCI对改善左心室功能无效。
多支血管直接PCI或分期PCI对某些STEMI合并多支冠状动脉疾病患者有效且安全。未来需要进行随机对照试验，以确定多支血管PCI的最佳时机，以及非罪犯狭窄中PCI的适当应用。
