Department of Internal Medicine, Michigan State University, Lansing, Michigan.
Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
JACC Cardiovasc Interv. 2020 Jul 13;13(13):1571-1582. doi: 10.1016/j.jcin.2020.04.055.
The goal of this systematic review and meta-analysis was to provide a comprehensive evaluation of contemporary randomized trials addressing the efficacy and safety of multivessel versus culprit vessel-only percutaneous coronary intervention (PCI) among patients presenting with ST-segment elevation myocardial infarction and multivessel coronary artery disease.
Multivessel coronary artery disease is present in about one-half of patients with ST-segment elevation myocardial infarction. Randomized controlled trials comparing multivessel and culprit vessel-only PCI produced conflicting results regarding the benefits of a multivessel PCI strategy.
A comprehensive search for published randomized controlled trials comparing multivessel PCI with culprit vessel-only PCI was conducted on ClinicalTrials.gov, PubMed, Web of Science, EBSCO Services, the Cochrane Central Register of Controlled Trials, Google Scholar, and scientific conference sessions from inception to September 15, 2019. A meta-analysis was performed using a random-effects model to calculate the risk ratio (RR) and 95% confidence interval (CI). Primary efficacy outcomes were all-cause mortality and reinfarction.
Ten randomized controlled trials were included, representing 7,030 patients: 3,426 underwent multivessel PCI and 3,604 received culprit vessel-only PCI. Compared with culprit vessel-only PCI, multivessel PCI was associated with no significant difference in all-cause mortality (RR: 0.85; 95% CI: 0.68 to 1.05) and lower risk for reinfarction (RR: 0.69; 95% CI: 0.50 to 0.95), cardiovascular mortality (RR: 0.71; 95% CI: 0.50 to 1.00), and repeat revascularization (RR: 0.34; 95% CI: 0.25 to 0.44). Major bleeding (RR: 0.92; 95% CI: 0.50 to 1.67), stroke (RR: 1.15; 95% CI: 0.65 to 2.01), and contrast-induced nephropathy (RR: 1.25; 95% CI: 0.80 to 1.95) were not significantly different between the 2 groups.
Multivessel PCI was associated with a lower risk for reinfarction, without any difference in all-cause mortality, compared with culprit vessel-only PCI in patients with ST-segment elevation myocardial infarction.
本系统评价和荟萃分析的目的是全面评估当代随机试验在 ST 段抬高型心肌梗死和多支血管病变患者中比较多支血管与罪犯血管血运重建的疗效和安全性。
大约一半的 ST 段抬高型心肌梗死患者存在多支血管病变。比较多支血管和罪犯血管血运重建的随机对照试验结果相互矛盾，多支血管血运重建策略的获益尚不清楚。
在 ClinicalTrials.gov、PubMed、Web of Science、EBSCO 服务、Cochrane 对照试验中心注册库、Google Scholar 和科学会议会议上，全面检索比较多支血管血运重建与罪犯血管血运重建的已发表随机对照试验，检索时间从建库至 2019 年 9 月 15 日。采用随机效应模型计算风险比（RR）和 95%置信区间（CI）进行荟萃分析。主要疗效终点为全因死亡率和再梗死。
纳入 10 项随机对照试验，共 7030 例患者：3426 例接受多支血管血运重建，3604 例接受罪犯血管血运重建。与罪犯血管血运重建相比，多支血管血运重建全因死亡率（RR：0.85；95%CI：0.68 至 1.05）和再梗死（RR：0.69；95%CI：0.50 至 0.95）、心血管死亡率（RR：0.71；95%CI：0.50 至 1.00）和再次血运重建（RR：0.34；95%CI：0.25 至 0.44）风险均无显著差异。大出血（RR：0.92；95%CI：0.50 至 1.67）、卒中和（RR：1.15；95%CI：0.65 至 2.01）和对比剂肾病（RR：1.25；95%CI：0.80 至 1.95）两组间无显著差异。
与罪犯血管血运重建相比，ST 段抬高型心肌梗死患者多支血管血运重建再梗死风险较低，但全因死亡率无差异。
