Cui Kongyong, Lyu Shuzheng, Song Xiantao, Liu Hong, Yuan Fei, Xu Feng, Zhang Min, Wang Wei, Zhang Mingduo, Zhang Dongfeng, Dai Jing, Tian Jinfan
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Coron Artery Dis. 2019 May;30(3):188-195. doi: 10.1097/MCA.0000000000000701.
The long-term relative benefit of culprit-only percutaneous coronary intervention (PCI) and staged PCI in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease remains disputable. This study aimed to compare the long-term outcomes of culprit-only PCI and in-hospital staged complete revascularization in real-world patients with STEMI and multivessel coronary artery disease.
A total of 452 patients were treated with in-hospital staged complete revascularization (n=133) or culprit-only PCI (n=319) between May 2012 and December 2015 in our center. The primary end point was major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of all-cause death, nonfatal myocardial infarction, stroke, and unplanned revascularization.
The median follow-up period was 3.2 years. Overall, treatment with in-hospital staged complete revascularization can reduce the incidence of the primary end point of MACCE in both the overall population [hazard ratio (HR): 0.48; 95% confidence interval (CI): 0.29-0.82] and the propensity-matched cohorts (HR: 0.51; 95% CI: 0.27-0.97). After correction of the possible confounders, staged PCI remained associated with decreased risk of MACCE (HR: 0.56; 95% CI: 0.33-0.96). Besides, the strategy of staged PCI tended to be associated with lower risk of a composite of cardiac death, myocardial infarction, and stroke than culprit-only PCI in multivariable-adjusted analysis (HR: 0.30; 95% CI: 0.09-1.01).
In patients with STEMI and multivessel disease undergoing primary PCI, an approach of in-hospital staged complete revascularization was associated with a better 3-year composite outcome compared with culprit-only PCI.
在ST段抬高型心肌梗死（STEMI）合并多支血管病变患者中，仅对罪犯血管进行经皮冠状动脉介入治疗（PCI）与分期PCI的长期相对获益仍存在争议。本研究旨在比较现实世界中STEMI合并多支冠状动脉疾病患者仅对罪犯血管进行PCI与住院期间分期完全血运重建的长期结局。
2012年5月至2015年12月期间，本中心共有452例患者接受了住院期间分期完全血运重建（n = 133）或仅对罪犯血管进行PCI（n = 319）。主要终点是主要不良心脑血管事件（MACCE），定义为全因死亡、非致命性心肌梗死、中风和非计划血运重建的综合。
中位随访期为3.2年。总体而言，住院期间分期完全血运重建治疗可降低总体人群[风险比（HR）：0.48；95%置信区间（CI）：0.29 - 0.82]和倾向匹配队列（HR：0.51；95% CI：0.27 - 0.97）中MACCE主要终点的发生率。校正可能的混杂因素后，分期PCI仍与MACCE风险降低相关（HR：0.56；95% CI：0.33 - 0.96）。此外，在多变量调整分析中，分期PCI策略与仅对罪犯血管进行PCI相比，心脏死亡、心肌梗死和中风综合风险较低（HR：0.30；95% CI：0.09 - 1.01）。
在接受直接PCI的STEMI合并多支血管病变患者中，与仅对罪犯血管进行PCI相比，住院期间分期完全血运重建方法与更好的3年综合结局相关。
