Correia César, Galvão Braga Carlos, Martins Juliana, Arantes Carina, Abreu Glória, Quina Catarina, Salgado Alberto, Álvares Pereira Miguel, Costa João, Marques Jorge
Escola de Ciências da Saúde, Universidade do Minho, Braga, Portugal.
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.
Rev Port Cardiol (Engl Ed). 2018 Feb;37(2):143-154. doi: 10.1016/j.repc.2017.05.010. Epub 2018 Feb 25.
There have been no prospective randomized trials that enable the best strategy and timing to be determined for revascularization in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel coronary artery disease (CAD).
To compare short- and long-term adverse events following multivessel vs. culprit-only revascularization in patients with NSTE-ACS and multivessel CAD.
This was a retrospective observational study that included all patients diagnosed with NSTE-ACS and multivessel CAD who underwent percutaneous coronary intervention (PCI) between January 2010 and June 2013 (n=232). After exclusion of patients with previous coronary artery bypass grafting (n=30), a multivessel revascularization strategy was adopted in 35.1% of patients (n=71); in the others (n=131, 64.9%), only the culprit artery was revascularized. After propensity score matching (PSM), two groups of 66 patients were obtained, matched according to revascularization strategy.
During follow-up (1543±545 days), after PSM, patients undergoing multivessel revascularization had lower rates of reinfarction (4.5% vs. 16.7%; log-rank p=0.018), unplanned revascularization (6.1% vs. 16.7%; log-rank p=0.048), unplanned PCI (3.0% vs. 13.6%; log-rank p=0.023) and the combined endpoint of death, reinfarction and unplanned revascularization (16.7 vs. 31.8%; log-rank p=0.046).
In real-world patients presenting with NSTE-ACS and multivessel CAD, a multivessel revascularization strategy was associated with lower rates of reinfarction, unplanned revascularization and unplanned PCI, as well as a reduction in the combined endpoint of death, reinfarction and unplanned revascularization.
尚无前瞻性随机试验能够确定非ST段抬高型急性冠状动脉综合征（NSTE-ACS）合并多支冠状动脉疾病（CAD）患者进行血运重建的最佳策略和时机。
比较NSTE-ACS合并多支CAD患者多支血管血运重建与仅罪犯血管血运重建后的短期和长期不良事件。
这是一项回顾性观察性研究，纳入了2010年1月至2013年6月期间所有诊断为NSTE-ACS合并多支CAD并接受经皮冠状动脉介入治疗（PCI）的患者（n=232）。排除既往有冠状动脉旁路移植术的患者（n=30）后，35.1%的患者（n=71）采用了多支血管血运重建策略；其他患者（n=131，64.9%）仅对罪犯血管进行血运重建。经过倾向评分匹配（PSM）后，获得了两组各66例患者，根据血运重建策略进行匹配。
在随访期间（1543±545天），PSM后，接受多支血管血运重建的患者再梗死率较低（4.5%对16.7%；对数秩检验p=0.018）、非计划性血运重建率较低（6.1%对16.7%；对数秩检验p=0.048）、非计划性PCI率较低（3.0%对13.6%；对数秩检验p=0.023）以及死亡、再梗死和非计划性血运重建的联合终点发生率较低（16.7%对31.8%；对数秩检验p=0.046）。
在现实世界中，患有NSTE-ACS合并多支CAD的患者，多支血管血运重建策略与较低的再梗死率、非计划性血运重建率和非计划性PCI率相关，同时降低了死亡、再梗死和非计划性血运重建的联合终点发生率。
