Garcia Daniel C, Benjo Alexandre M, White Christopher J, Cardoso Rhanderson N, Macedo Francisco Y B, Schob Alan H, El-Hayek Georges E, Nadkarni Girish N, Aziz Emad F, Patel Rajan A G
Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA.
The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA.
Ochsner J. 2019 Summer;19(2):107-115. doi: 10.31486/toj.18.0033.
Primary percutaneous coronary intervention (PCI) is the most frequently used treatment modality for patients presenting with ST elevation myocardial infarction (STEMI). Current professional society guidelines recommend culprit artery only PCI. Recent evidence suggests the potential benefit of multivessel PCI among patients with STEMI that is not complicated by cardiogenic shock. We systematically searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for clinical studies of patients with STEMI, not complicated by cardiogenic shock, who underwent primary PCI between January 1966 and January 2018. We evaluated all-cause and cardiovascular mortality, reinfarction, and repeat revascularization among patients randomized to a multivessel PCI strategy compared to a culprit artery only PCI strategy. Four randomized clinical trials with a total of 1,044 patients met the inclusion criteria. Five hundred and sixty-six patients underwent multivessel PCI, and 478 patients underwent culprit artery only PCI. Multivessel PCI reduced all the studied endpoints: total death, cardiac death, reinfarction, and repeat revascularization (all values <0.05). To our knowledge, this is the largest metaanalysis of randomized controlled trials studying multivessel PCI vs culprit artery only PCI in STEMI patients without shock, among whom lesion severity was graded by angiography alone. We found that compared to culprit artery only PCI, the multivessel PCI strategy was beneficial in reducing all-cause and cardiovascular mortality, reinfarction, and the need for repeat revascularization.
直接经皮冠状动脉介入治疗（PCI）是ST段抬高型心肌梗死（STEMI）患者最常用的治疗方式。当前专业学会指南推荐仅对罪犯血管进行PCI。最近的证据表明，在无心源性休克的STEMI患者中，多支血管PCI可能有益。我们系统检索了PubMed、EMBASE和Cochrane对照试验中央注册库，以查找1966年1月至2018年1月期间接受直接PCI且无心源性休克的STEMI患者的临床研究。我们评估了随机分配至多支血管PCI策略与仅对罪犯血管进行PCI策略的患者的全因死亡率、心血管死亡率、再梗死和再次血运重建情况。四项共纳入1044例患者的随机临床试验符合纳入标准。566例患者接受了多支血管PCI，478例患者仅接受了罪犯血管PCI。多支血管PCI降低了所有研究终点：总死亡、心源性死亡、再梗死和再次血运重建（所有P值<0.05）。据我们所知，这是对无休克的STEMI患者中多支血管PCI与仅对罪犯血管进行PCI的随机对照试验进行的最大规模荟萃分析，其中病变严重程度仅通过血管造影分级。我们发现，与仅对罪犯血管进行PCI相比，多支血管PCI策略在降低全因死亡率、心血管死亡率、再梗死以及再次血运重建需求方面有益。
