75岁以上ST段抬高型心肌梗死患者的多支血管病变。ESTROFA MI+75全国注册研究中的当前管理策略及相关临床结局
Multivessel disease in patients over 75years old with ST elevated myocardial infarction. Current management strategies and related clinical outcomes in the ESTROFA MI+75 nation-wide registry.
作者信息
de La Torre Hernandez Jose M, Gomez Hospital Joan A, Baz Jose A, Brugaletta Salvatore, Perez de Prado Armando, Linares Jose A, Lopez Palop Ramón, Cid Belen, Garcia Camarero Tamara, Diego Alejandro, Gutierrez Hipolito, Fernandez Diaz Jose A, Sanchis Juan, Alfonso Fernando, Blanco Roberto, Botas Javier, Navarro Cuartero Javier, Moreu Jose, Bosa Francisco, Vegas Jose M, Elizaga Jaime, Arrebola Antonio L, Hernandez Felipe, Salvatella Neus, Monteagudo Marta, Gomez Jaume Alfredo, Carrillo Xavier, Martin Reyes Roberto, Lozano Fernando, Rumoroso Jose R, Andraka Leire, Dominguez Antonio J
机构信息
Hospital Universitario Marques de Valdecilla, Servicio de Cardiologia, Santander, Spain.
Hospital de Bellvitge, Barcelona, Spain.
出版信息
Cardiovasc Revasc Med. 2018 Jul-Aug;19(5 Pt B):580-588. doi: 10.1016/j.carrev.2017.12.004. Epub 2017 Dec 6.
BACKGROUND
In elderly patients with ST elevated myocardial infarction (STEMI) and multivessel disease (MVD the outcomes related with different revascularization strategies are not well known.
METHODS
Subgroup-analysis of a nation-wide registry of primary angioplasty in the elderly (ESTROFA MI+75) with 3576 patients over 75years old from 31 centers. Patients with MVD were analyzed to describe treatment approaches and 2years outcomes.
RESULTS
Of 1830 (51%) with MVD, 847 (46%) underwent multivessel revascularization either in acute (51%), staged (44%) or both procedures (5%). Patients with previous myocardial infarction and those receiving drug-eluting stents or IIb-IIIa inhibitors were more prone to be revascularized, whereas older patients, females and those with Killip III-IV, renal failure and higher ejection fraction were less likely. Survival free of cardiac death and infarction at 2years was better for those undergoing multivessel PCI (85.8% vs. 80.4%, p<0.0008), regardless of Killip class. Multivessel PCI was protective of cardiac death and infarction (HR 0.60, 95% CI 0.40-0.89; p=0.011). Complete revascularization made no difference in outcomes among those patients undergoing multivessel PCI. The best prognosis corresponded to those undergoing multivessel PCI in staged procedures (p<0.001). A propensity score matching analysis (514 patients in each group) yielded similar results.
CONCLUSIONS
In elderly patients with STEMI and MVD, multivessel PCI was related with better outcomes especially after staged procedures. Among those undergoing multivessel PCI, anatomically defined completeness of revascularization had not prognostic influence.
SUMMARY
We sought to investigate the revascularization strategies applied and their prognostic implications in patients aged over 75years with ST elevated myocardial infarction showing multivessel disease. Of 1830 patients, 847 (46%) underwent multivessel PCI either in acute (51%), staged (44%) or both procedures (5%). Multivessel PCI was independent predictor of cardiac death and infarction with the best prognosis corresponding to those undergoing staged procedures.
背景
在老年ST段抬高型心肌梗死（STEMI）合并多支血管病变（MVD）患者中，不同血运重建策略的相关预后尚不明确。
方法
对一项全国性的老年患者（年龄≥75岁）直接PCI注册研究（ESTROFA MI+75）进行亚组分析，该研究纳入了来自31个中心的3576例患者。对合并MVD的患者进行分析，以描述治疗方法和2年预后。
结果
在1830例（51%）合并MVD的患者中，847例（46%）接受了多支血管血运重建，其中急性血运重建（51%）、分期血运重建（44%）或两种方式均采用（5%）。既往有心肌梗死病史的患者以及接受药物洗脱支架或IIb-IIIa抑制剂治疗的患者更倾向于接受血运重建，而老年患者、女性患者以及Killip III-IV级、肾功能衰竭和射血分数较高的患者接受血运重建的可能性较小。无论Killip分级如何，接受多支血管PCI的患者2年无心脏死亡和梗死的生存率更高（85.8% vs. 80.4%，p<0.0008）。多支血管PCI可降低心脏死亡和梗死风险（HR 0.60，95%CI 0.40-0.89；p=0.011）。对于接受多支血管PCI的患者，完全血运重建对预后无影响。预后最佳的是接受分期多支血管PCI的患者（p<0.001）。倾向评分匹配分析（每组514例患者）得出了相似的结果。
结论
在老年STEMI合并MVD患者中，多支血管PCI尤其是分期手术后预后更佳。在接受多支血管PCI的患者中，解剖学上定义的血运重建完整性对预后无影响。
总结
我们旨在研究在年龄≥75岁的ST段抬高型心肌梗死合并多支血管病变患者中应用的血运重建策略及其预后意义。在1830例患者中，847例（46%）接受了多支血管PCI，其中急性血运重建（51%）、分期血运重建（44%）或两种方式均采用（5%）。多支血管PCI是心脏死亡和梗死的独立预测因素，预后最佳的是接受分期手术的患者。
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