Fagel N D, van Nooijen F C, Maarse M, Slagboom T, Herrman J P, van der Schaaf R J, Amoroso G, Patterson M S, Laarman G J, Suttorp M J, Vink M A
Department of Cardiology, OLVG Hospital, Amsterdam, The Netherlands.
Department of Cardiology, Waterland Hospital, Purmerend, The Netherlands.
Neth Heart J. 2019 Jun;27(6):310-320. doi: 10.1007/s12471-019-1252-3.
OBJECTIVES/BACKGROUND: In patients with multivessel coronary artery disease (MVD) the decision whether to treat a single culprit vessel or to perform multivessel revascularisation may be challenging. The purpose of this study was to evaluate the long-term outcome of multivessel percutaneous coronary intervention (MV-PCI) versus culprit vessel only (CV-PCI) in patients with stable coronary artery disease or non-ST elevation acute coronary syndrome.
In this dual-centre, prospective, randomised study a total 215 patients with MVD were randomly assigned to MV-PCI or CV-PCI. The primary endpoint was the occurrence of major adverse cardiac events (MACE) including death, myocardial infarction (MI), and repeat revascularisation. Secondary endpoints were the combined endpoint of death or MI, the individual components of the primary endpoint, and the occurrence of stent thrombosis. Patients were followed up to 5 years after enrolment.
The occurrence of the primary endpoint was similar at 28% versus 31% in the MV-PCI and CV-PCI group, respectively (hazard ratio [HR] 0.87, 95% confidence interval [CI]: 0.53-1.44, p = 0.59). The rate of repeat revascularisation was 15% versus 24% (HR 0.59, 95% CI 0.32 to 1.11, p = 0.11), whereas definite or probable stent thrombosis occurred in 2% versus 0% (p = 0.44).
In this randomised study comparing the strategies for MV-PCI and CV-PCI in patients with MVD, no difference was found in the occurrence of MACE after 5 years. We observed a numerically higher rate of death or MI and a lower rate of repeat revascularisation after MV-PCI, although these findings were not statistically significant.
目的/背景:对于多支冠状动脉疾病(MVD)患者,决定是治疗单支罪犯血管还是进行多支血管血运重建可能具有挑战性。本研究的目的是评估多支血管经皮冠状动脉介入治疗(MV-PCI)与仅治疗罪犯血管(CV-PCI)在稳定型冠状动脉疾病或非ST段抬高型急性冠状动脉综合征患者中的长期结局。
在这项双中心、前瞻性、随机研究中,总共215例MVD患者被随机分配接受MV-PCI或CV-PCI。主要终点是主要不良心脏事件(MACE)的发生,包括死亡、心肌梗死(MI)和再次血运重建。次要终点是死亡或MI的联合终点、主要终点的各个组成部分以及支架血栓形成的发生。患者在入组后随访5年。
MV-PCI组和CV-PCI组的主要终点发生率相似,分别为28%和31%(风险比[HR]0.87,95%置信区间[CI]:0.53-1.44,p = 0.59)。再次血运重建率分别为15%和24%(HR 0.59, 95% CI 0.32至1.11, p = 0.11),而明确或可能的支架血栓形成发生率分别为2%和0%(p = 0.44)。
在这项比较MVD患者MV-PCI和CV-PCI策略的随机研究中,5年后MACE的发生率没有差异。我们观察到MV-PCI后死亡或MI的发生率在数值上更高,再次血运重建率更低,尽管这些结果没有统计学意义。