Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
JACC Cardiovasc Interv. 2020 Jul 13;13(13):1557-1567. doi: 10.1016/j.jcin.2020.04.034.
The aim of this study was to evaluate the long-term outcomes of patients with acute coronary syndromes (ACS) with multivessel disease undergoing percutaneous coronary intervention (PCI).
Controversy exists regarding the benefit of multivessel PCI across the spectrum of ACS.
A total of 9,094 patients with ACS and multivessel disease (≥70% stenosis in 2 or more major epicardial vessels) undergoing PCI from the Alberta COAPT (Contemporary Acute Coronary Syndrome Patients Invasive Treatment Strategies) registry (April 1, 2007, to March 31, 2013) were reviewed. Comparisons were made between patients who underwent complete revascularization and those with incomplete revascularization. Complete revascularization was defined as multivessel PCI with a residual angiographic jeopardy score ≤10%. Associations between revascularization status and all-cause death or new myocardial infarction (primary composite endpoint) and all-cause death, new myocardial infarction, or repeat revascularization (secondary composite endpoint) were evaluated.
Of the study cohort, 66.0% underwent complete revascularization. Compared with incomplete revascularization, the primary composite endpoint occurred less frequently with complete revascularization (event rate within 5 years 15.4% vs. 22.2%; inverse probability-weighted hazard ratio [IPW-HR]: 0.78; 95% confidence interval [CI]: 0.73 to 0.84; p < 0.0001). The secondary composite endpoint was less likely to occur with complete revascularization (event rate within 5 years 23.3% vs. 37.5%; IPW-HR: 0.61; 95% CI: 0.58 to 0.65; p < 0.0001). Complete revascularization was associated with a reduction in all-cause death (IPW-HR: 0.79; 95% CI: 0.73 to 0.86; p = 0.0004), new myocardial infarction (IPW-HR: 0.76; 95% CI: 0.69 to 0.84; p < 0.0001), and repeat revascularization (IPW-HR: 0.53; 95% CI: 0.49 to 0.57; p < 0.0001).
Results from this large contemporary registry of patients with ACS and PCI for multivessel disease suggest that complete revascularization occurs commonly and is associated with improved clinical outcomes (including survival) within 5 years.
本研究旨在评估接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）合并多支血管病变患者的长期预后。
关于 ACS 患者多支血管 PCI 的获益存在争议。
对 2007 年 4 月 1 日至 2013 年 3 月 31 日 Alberta COAPT（当代急性冠状动脉综合征患者介入治疗策略）注册研究中接受 PCI 的 9094 例 ACS 合并多支血管病变（≥2 个主要心外膜血管存在≥70%狭窄）患者进行了回顾性分析。比较完全血运重建与不完全血运重建患者的结果。完全血运重建定义为多支血管 PCI 后残余血管造影危险评分≤10%。评估血运重建状态与全因死亡或新发心肌梗死（主要复合终点）以及全因死亡、新发心肌梗死或再次血运重建（次要复合终点）之间的相关性。
研究队列中，66.0%的患者接受了完全血运重建。与不完全血运重建相比，完全血运重建后主要复合终点的发生率较低（5 年内发生率为 15.4%比 22.2%；校正后风险比 [HR]：0.78；95%置信区间 [CI]：0.73 至 0.84；p<0.0001）。完全血运重建后次要复合终点的发生率较低（5 年内发生率为 23.3%比 37.5%；校正后 HR：0.61；95%CI：0.58 至 0.65；p<0.0001）。完全血运重建与全因死亡降低相关（校正后 HR：0.79；95%CI：0.73 至 0.86；p=0.0004）、新发心肌梗死（校正后 HR：0.76；95%CI：0.69 至 0.84；p<0.0001）和再次血运重建（校正后 HR：0.53；95%CI：0.49 至 0.57；p<0.0001）。
这项针对 ACS 合并多支血管病变患者接受 PCI 治疗的大型当代注册研究结果表明，完全血运重建较为常见，并与 5 年内临床结局（包括生存率）的改善相关。
