Alsadat Noor, Hyun Karice, D'Souza Mario, Chew Derek, Weaver James, Juergens Craig, Kritharides Leonard, Hammett Christopher, Brieger David
7 Concord Repatriation General Hospital, The University of Sydney, NSW, Australia.
J Invasive Cardiol. 2019 Nov;31(11):314-318. Epub 2019 Jul 15.
Approximately 50% of patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) have multivessel coronary disease (MVD). Evidence on the best PCI approach for these patients is conflicting. The aim of this study is to examine Australian data from the CONCORDANCE registry to describe the practice and outcomes of patients receiving multivessel vs culprit-only PCI.
Two cohorts were constructed from MVD-STEMI patients undergoing primary PCI at 41 hospitals between 2009 and 2015: culprit-only PCI (n = 587; 87%) and multivessel PCI (n = 82; 12%). Clinical characteristics were described, and the outcomes were all-cause mortality, heart failure, and myocardial reinfarction, in-hospital and at 6-month follow-up. The relative prevalence of each procedure over time was also described.
The patient cohorts were comparable in age, sex, and cardiovascular risk factors. Patients with higher Killip scores were more likely to receive multivessel PCI (P=.02). The multivessel group was significantly more likely to have in-hospital cardiogenic shock (P<.01), myocardial reinfarction (P=.02), cardiac arrest (P=.02), and stroke (P=.01). There was no difference in the incidence of ischemic events at 6 months, but the multivessel group had a lower rate of planned repeat revascularizations (12% vs 2%; P=.03). There was no difference in the relative frequency of multivessel vs culprit-only PCI during the observation period.
The relative frequency of multivessel vs culprit-only PCI has not changed from 2009-2015. Index complete revascularization for STEMI-MVD patients is more likely to be performed in those with worse presentations and is associated with worse in-hospital complications.
接受ST段抬高型心肌梗死（STEMI）直接经皮冠状动脉介入治疗（PCI）的患者中，约50%患有多支冠状动脉疾病（MVD）。关于这些患者最佳PCI治疗方法的证据存在冲突。本研究的目的是研究澳大利亚CONCORDANCE注册研究的数据，以描述接受多支血管PCI与仅对罪犯血管进行PCI的患者的治疗情况和结局。
从2009年至2015年在41家医院接受直接PCI的MVD-STEMI患者中构建两个队列：仅对罪犯血管进行PCI（n = 587；87%）和多支血管PCI（n = 82；12%）。描述了临床特征，并在住院期间和6个月随访时观察了全因死亡率、心力衰竭、心肌再梗死等结局。还描述了每种手术随时间的相对患病率。
患者队列在年龄、性别和心血管危险因素方面具有可比性。Killip评分较高的患者更有可能接受多支血管PCI（P = 0.02）。多支血管组在住院期间发生心源性休克（P < 0.01）、心肌再梗死（P = 0.02）、心脏骤停（P = 0.02）和中风（P = 0.01）的可能性显著更高。6个月时缺血事件的发生率没有差异，但多支血管组计划再次血管重建的发生率较低（12%对2%；P = 0.03）。观察期内多支血管PCI与仅对罪犯血管进行PCI的相对频率没有差异。
2009年至2015年期间，多支血管PCI与仅对罪犯血管进行PCI的相对频率没有变化。STEMI-MVD患者的首次完全血管重建更有可能在病情较重的患者中进行，并且与更差的住院并发症相关。
