Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
Catheter Cardiovasc Interv. 2019 Apr 1;93(5):E262-E268. doi: 10.1002/ccd.27896. Epub 2018 Sep 23.
BACKGROUND: The optimum timing of revascularization strategy for stenoses in nonculprit vessels in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) remains unclear. At present, there is no evidence investigating the outcome of staged percutaneous coronary intervention (PCI) within two weeks from admission among STEMI patients with MVD. METHODS: A total of 210 STEMI patients with MVD who underwent primary PCI were analyzed. We compared the all-cause mortality and major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, heart failure, unstable angina, and stroke) with median follow-up of 1200 days among the patients who underwent staged PCI within two weeks from admission (staged PCI ≤2 W) (n = 75), staged PCI after two weeks from admission (staged PCI >2 W) (n = 37) and culprit-only PCI (n = 98) in patients with STEMI and MVD. RESULTS: The staged PCI ≤2 W showed lower all-cause mortality than culprit-only PCI (4.0 vs 29.6%, log-rank P = 0.001), and lower incidence of MACE than the staged PCI >2 W group (1.3 vs 18.9%, log-rank P = 0.001) and culprit-only PCI group (1.3 vs 22.5%, log-rank P = 0.001). In the multivariable Cox regression analysis, the staged PCI ≤2 W was a predictor of lower all-cause mortality (hazard ratio [HR], 0.176; 95% confidence interval [CI], 0.049-0.630; P = 0.008) and lower incidence of MACE (HR, 0.068; 95% CI, 0.009-0.533; P = 0.011), but staged PCI >2 W was not. CONCLUSION: In conclusion, staged PCI within two weeks after admission showed more favorable outcomes compared with staged PCI after two weeks from admission or culprit-only PCI in STEMI patients with MVD.
背景：ST 段抬高型心肌梗死（STEMI）合并多血管病变（MVD）患者非罪犯血管狭窄的血运重建策略的最佳时机仍不清楚。目前，尚无证据表明 STEMI 合并 MVD 患者在入院后两周内行分期经皮冠状动脉介入治疗（PCI）的结局。
方法：共分析了 210 例接受直接 PCI 的 STEMI 合并 MVD 患者。我们比较了在 STEMI 合并 MVD 患者中，在入院后两周内行分期 PCI（分期 PCI≤2 周）（n=75）、在入院后两周内行分期 PCI（分期 PCI＞2 周）（n=37）和罪犯血管 PCI（n=98）的全因死亡率和主要不良心血管事件（MACE）（心血管死亡、心肌梗死、心力衰竭、不稳定型心绞痛和卒中等），中位随访时间为 1200 天。
结果：分期 PCI≤2 周的全因死亡率低于罪犯血管 PCI（4.0% vs 29.6%，log-rank P=0.001），MACE 的发生率低于分期 PCI＞2 周组（1.3% vs 18.9%，log-rank P=0.001）和罪犯血管 PCI 组（1.3% vs 22.5%，log-rank P=0.001）。多变量 Cox 回归分析显示，分期 PCI≤2 周是全因死亡率（风险比[HR]，0.176；95%置信区间[CI]，0.049-0.630；P=0.008）和 MACE 发生率（HR，0.068；95% CI，0.009-0.533；P=0.011）降低的预测因素，但分期 PCI＞2 周不是。
结论：总之，与入院后两周内行分期 PCI 或罪犯血管 PCI 相比，STEMI 合并 MVD 患者在入院后两周内行分期 PCI 可获得更好的结局。
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