Department of Cardiology, Hospital Universitario A Coruña, INIBIC, Spain (R.C.-S., J.P.-V., J.S.-F., A.B.-M., J.A.R.-F., G.A.-L., P.P.-E., X.F.-R., R.S.-M., T.S.-P., N.V.-G., J.M.V.-R.).
Department of Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain (R.E.-L.).
Circ Cardiovasc Interv. 2019 Oct;12(10):e007924. doi: 10.1161/CIRCINTERVENTIONS.119.007924. Epub 2019 Sep 26.
Recent trials suggest that complete revascularization in patients with acute ST-segment-elevation myocardial infarction and multivessel disease is associated with better outcomes than infarct-related artery (IRA)-only revascularization. There are different methods to select non-IRA lesions for revascularization procedures. We assessed the clinical outcomes of complete angiographically guided revascularization versus stress echocardiography-guided revascularization in patients with ST-segment-elevation myocardial infarction.
We performed a randomized clinical trial in patients with multivessel disease who underwent a successful percutaneous coronary intervention of the IRA to test differences in prognosis (composite end point included cardiovascular mortality, nonfatal reinfarction, coronary revascularization, and readmission for heart failure after 12 months of follow-up) between complete angiographically guided revascularization (n=154) or stress echocardiography-guided revascularization (n=152) of the non-IRA lesions in an elective procedure before hospital discharge.
The trial was prematurely stopped after the inclusion of 77% of the planned study population. As many as 152 (99%) patients in the complete revascularization group and 44 (29%) patients in the selective revascularization group required a percutaneous coronary intervention procedure of a non-IRA lesion before discharge. The primary end point occurred in 21 (14%) patients of the stress echocardiography-guided revascularization group and 22 (14%) patients of the complete angiographically guided revascularization group (hazard ratio, 0.95; 95% CI, 0.52-1.72; =0.85).
In patients with ST-segment-elevation myocardial infarction and multivessel disease, stress echocardiography-guided revascularization may not be significantly different to complete angiographically guided revascularization, thereby reducing the need for elective revascularization before hospital discharge.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01179126.
最近的试验表明，急性 ST 段抬高型心肌梗死和多支血管病变患者的完全血运重建比梗死相关动脉（IRA）血运重建效果更好。有不同的方法选择非 IRA 病变进行血运重建。我们评估了 ST 段抬高型心肌梗死患者完全血管造影指导的血运重建与应激超声心动图指导的血运重建的临床结局。
我们对多支血管病变患者进行了一项随机临床试验，这些患者成功接受了 IRA 的经皮冠状动脉介入治疗，以测试在 IRA 成功血运重建后 12 个月的随访期间，完全血管造影指导的血运重建（n=154）或应激超声心动图指导的非 IRA 病变血运重建（n=152）之间预后（复合终点包括心血管死亡率、非致死性再梗死、冠状动脉血运重建和心力衰竭再入院）的差异。
该试验在纳入计划研究人群的 77%后提前停止。完全血运重建组 152 例（99%）和选择性血运重建组 44 例（29%）患者在出院前需要进行非 IRA 病变的经皮冠状动脉介入治疗。应激超声心动图指导的血运重建组有 21 例（14%）患者和完全血管造影指导的血运重建组有 22 例（14%）患者发生主要终点（危险比，0.95；95%CI，0.52-1.72；=0.85）。
在 ST 段抬高型心肌梗死和多支血管病变患者中，应激超声心动图指导的血运重建与完全血管造影指导的血运重建可能没有显著差异，从而减少了出院前选择性血运重建的需要。
