University of Utah Cardiovascular division, Salt Lake City, UT
Tri-City Cardiology Consultants, Mesa, AZ.
J Am Heart Assoc. 2017 Oct 5;6(10):e006343. doi: 10.1161/JAHA.117.006343.
Among patients with acute myocardial infarction (MI) who have multivessel disease, it is unclear if multivessel percutaneous coronary intervention (PCI) improves clinical and quality-of-life outcomes compared with culprit-only intervention. We sought to compare clinical and quality-of-life outcomes between multivessel and culprit-only PCI.
Among 6061 patients with acute MI who have multivessel disease in the TRANSLATE-ACS (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study, we used inverse probability-weighted propensity adjustment to study the associations between multivessel and culprit-only intervention during the index PCI and major adverse cardiovascular events, unplanned all-cause readmission, and angina frequency at 6 weeks and 1 year. Multivessel PCI was performed in 1208 (20%) of patients with MI who had multivessel disease. Relative to the culprit-only intervention, patients receiving multivessel PCI were similarly aged and more likely to be seen with non-ST-segment elevation MI or cardiogenic shock. At 6 weeks, the initial multivessel PCI strategy was associated with lower major adverse cardiovascular events and unplanned readmission risks, whereas angina frequency was not significantly different between multivessel and culprit-only PCI. At 1 year, major adverse cardiovascular event risk was persistently lower in the multivessel PCI group (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72-0.99), whereas long-term readmission risk (adjusted hazard ratio, 0.94; 95% confidence interval, 0.84-1.04) and angina frequency were similar between groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.82-1.24). Similar associations were seen when patients with ST-segment elevation MI and non-ST-segment elevation MI were examined separately.
Among patients with acute MI who have multivessel disease, multivessel PCI was associated with lower risk of all-cause readmission at 6 weeks and lower risk of major adverse cardiovascular events at 6 weeks and 1 year. However, similar short- and long-term angina frequencies were noted.
对于患有多支血管疾病的急性心肌梗死（MI）患者，多支血管经皮冠状动脉介入治疗（PCI）与罪犯血管 PCI 相比是否能改善临床和生活质量结局尚不清楚。我们旨在比较多支血管和罪犯血管 PCI 的临床和生活质量结局。
在 TRANSLATE-ACS（急性冠状动脉综合征治疗中使用二磷酸腺苷受体抑制剂：治疗后纵向评估治疗模式和事件）研究中，我们纳入了 6061 例多支血管疾病合并急性 MI 的患者，使用逆概率加权倾向调整分析多支血管 PCI 和罪犯血管 PCI 指数 PCI 期间与主要心血管不良事件、非计划全因再入院和 6 周及 1 年时心绞痛频率之间的相关性。在多支血管疾病合并 MI 的患者中，有 1208 例（20%）接受了多支血管 PCI。与罪犯血管 PCI 相比，接受多支血管 PCI 的患者年龄相似，更可能患有非 ST 段抬高型心肌梗死或心源性休克。6 周时，初始多支血管 PCI 策略与较低的主要心血管不良事件和非计划再入院风险相关，而多支血管 PCI 和罪犯血管 PCI 之间的心绞痛频率无显著差异。1 年时，多支血管 PCI 组的主要心血管不良事件风险持续降低（调整后的危险比为 0.84；95%置信区间为 0.72-0.99），而长期再入院风险（调整后的危险比为 0.94；95%置信区间为 0.84-1.04）和心绞痛频率在两组间相似（调整后的比值比为 1.01；95%置信区间为 0.82-1.24）。当分别对 ST 段抬高型心肌梗死和非 ST 段抬高型心肌梗死患者进行检查时，观察到了相似的关联。
对于多支血管疾病合并急性 MI 的患者，多支血管 PCI 与 6 周时全因再入院风险降低以及 6 周和 1 年时主要心血管不良事件风险降低相关。然而，两组的短期和长期心绞痛频率相似。
