Hawranek Michał, Desperak Piotr, Gąsior Paweł, Desperak Aneta, Lekston Andrzej, Gąsior Mariusz
3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease in Zabrze, Poland.
3 Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine in Katowice, Poland.
Postepy Kardiol Interwencyjnej. 2018;14(1):32-41. doi: 10.5114/aic.2018.74353. Epub 2018 Mar 22.
The clinical significance of complete revascularization with percutaneous coronary intervention (CR-PCI) in patients with non-ST-segment acute coronary syndrome (NSTE-ACS) remains uncertain.
To evaluate the impact of CR-PCI during index hospitalization on short and long-term incidence of death and composite endpoint among patients with multivessel coronary artery disease (CAD) presenting with NSTE-ACS.
We analyzed consecutive data of 1,592 patients with multivessel CAD from 2006 to 2014. Patients with prior coronary artery bypass grafting (CABG), cardiogenic shock, treated conservatively or with CABG and scheduled for planned CABG or PCI after discharge were excluded. The 30-day and 12-month composite endpoint was defined as all-cause death, nonfatal myocardial infarction (MI) or ACS-driven unplanned revascularization. Six hundred and ninety-five patients were divided into 2 groups: CR-PCI ( = 137) (CR-PCI during index hospitalization) and IR-PCI ( = 558) (incomplete revascularization).
Incidence of composite endpoint (3.6% vs. 10.2%; HR = 0.31; 95% CI: 0.12-0.87; = 0.025) and death (0.7% vs. 5.7%, HR = 0.11; 95% CI: 0.02-0.93; = 0.043) at 30 days was lower in CR-PCI than in IR-PCI. At 12-month follow-up occurrence of composite endpoint was lower in CR-PCI (14.7%) than in IR-PCI (27.4%, = 0.0037). Multivariate analysis confirmed that CR PCI was associated with a reduction in 12-month composite endpoint (HR = 0.56; 95% CI: 0.31-0.99; = 0.046). The 12-month mortality was lower in CR-PCI (7.4% vs. 14.8%; = 0.031), but it was not confirmed in the multivariate analysis.
In patients with multivessel CAD and NSTE-ACS, CR-PCI during index hospitalization was independently associated with improved early and long-term prognosis without significant differences in periprocedural outcomes in comparison to IR-PCI.
经皮冠状动脉介入治疗实现完全血运重建（CR-PCI）在非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者中的临床意义仍不明确。
评估初次住院期间进行CR-PCI对多支冠状动脉疾病（CAD）合并NSTE-ACS患者短期和长期死亡及复合终点事件发生率的影响。
我们分析了2006年至2014年1592例多支CAD患者的连续数据。排除既往有冠状动脉旁路移植术（CABG）、心源性休克、接受保守治疗或CABG且出院后计划进行CABG或PCI的患者。30天和12个月的复合终点定义为全因死亡、非致命性心肌梗死（MI）或ACS驱动的非计划血运重建。695例患者分为2组：CR-PCI组（n = 137）（初次住院期间进行CR-PCI）和IR-PCI组（n = 558）（不完全血运重建）。
CR-PCI组30天时复合终点事件发生率（3.6%对10.2%；HR = 0.31；95%CI：0.12 - 0.87；P = 0.025）和死亡率（0.7%对5.7%，HR = 0.11；95%CI：0.02 - 0.93；P = 0.043）低于IR-PCI组。在12个月随访时，CR-PCI组复合终点事件发生率（14.7%）低于IR-PCI组（27.4%，P = 0.0037）。多变量分析证实CR-PCI与12个月复合终点事件减少相关（HR = 0.56；95%CI：0.31 - 0.99；P = 0.046）。CR-PCI组12个月死亡率较低（7.4%对14.8%；P = 0.031），但多变量分析未证实这一点。
在多支CAD合并NSTE-ACS患者中，初次住院期间进行CR-PCI与早期和长期预后改善独立相关，与IR-PCI相比，围手术期结局无显著差异。
