Enezate Tariq, Gifft Kristina, Chen Cliff, Omran Jad, Eniezat Mohammad, Reardon Michael
Division of Cardiology, UCLA-Harbor Medical Center, Los Angeles, CA, USA.
Department of Internal Medicine, University of Missouri Health Care, Columbia, MO, USA.
Cardiovasc Revasc Med. 2021 Oct;31:50-54. doi: 10.1016/j.carrev.2020.12.012. Epub 2020 Dec 11.
Acute myocardial infarction (AMI) is a common medical condition in our clinical practice that should be treated with appropriate revascularization in a timely manner. Percutaneous revascularization (PR) has been the first-line treatment option when feasible. Limited data is available comparing PR to surgical revascularization (SR) in the AMI setting.
Study population was extracted from the 2016 Nationwide Readmissions Data using International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for AMI, PR, SR, and procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospital stay (LOS), stroke, acute kidney injury, bleeding, need for blood transfusion, acute respiratory failure, and total hospital charges.
The study identified 45,539 discharges with a principal admission diagnosis of AMI (38.7% ST elevation and 61.3% non-ST elevation) who had either PR or SR as a principal procedure (79.1% PR versus 20.9% SR). Single vessel revascularization was performed in 67.8% (93.1% had PR versus 6.9% had SR, p < 0.01). Multivessel revascularization was performed in 32.2% (64.8% had PR versus 35.2% had SR, p < 0.01). 83% of SR was in the setting of non-ST elevation AMI (NSTEMI). In comparison to SR, PR was associated with higher in-hospital all-cause mortality (3.7% versus 2.2%, p < 0.01), shorter LOS (4.3 versus 11.6 days, p < 0.01), and lower incidence of post-procedural stroke (1.0% versus 1.8%, p < 0.01), acute kidney injury (14.9% versus 24.8%, p < 0.01), bleeding (4.3% versus 47.1%, p < 0.01), need for blood transfusion (2.9% versus 18.5%, p < 0.01), acute respiratory failure (10.7% versus 19.8%, p < 0.01), and total hospital charges (120,590$ versus 229,917$, p < 0.01). These results persist after adjustment for baseline characteristics. In a subgroup analysis, SR mortality benefit persisted in patients who had multivessel revascularization (in both ST and non-ST elevation AMI), but not in single vessel revascularization.
In patients presented with AMI, PR was associated with higher in-hospital all-cause mortality but lower morbidity, shorter LOS, and lower total hospital charges than SR. However, the mortality benefit of SR was seen in multivessel revascularization only, and not in single vessel revascularization.
急性心肌梗死（AMI）是我们临床实践中常见的病症，应及时进行适当的血运重建治疗。在可行的情况下，经皮血运重建（PR）一直是一线治疗选择。在急性心肌梗死的情况下，将PR与外科血运重建（SR）进行比较的数据有限。
使用国际疾病分类第十版临床修正版/程序编码系统中关于AMI、PR、SR和手术并发症的编码，从2016年全国再入院数据中提取研究人群。研究终点包括院内全因死亡率、首次住院时间（LOS）、中风、急性肾损伤、出血、输血需求、急性呼吸衰竭和总住院费用。
该研究确定了45539例主要入院诊断为AMI的出院病例（38.7%为ST段抬高型，61.3%为非ST段抬高型），这些病例将PR或SR作为主要手术（79.1%为PR，20.9%为SR）。67.8%进行了单支血管血运重建（93.1%接受PR，6.9%接受SR，p<0.01）。32.2%进行了多支血管血运重建（64.8%接受PR，35.2%接受SR，p<0.01）。83%的SR发生在非ST段抬高型急性心肌梗死（NSTEMI）患者中。与SR相比，PR与更高的院内全因死亡率相关（3.7%对2.2%，p<0.01）、更短的住院时间（4.3天对11.6天，p<0.01）以及更低的术后中风发生率（1.0%对1.8%，p<0.01）、急性肾损伤发生率（14.9%对24.8%，p<0.01）、出血发生率（4.3%对47.1%，p<0.01）、输血需求（2.9%对18.5%，p<0.01）、急性呼吸衰竭发生率（十.7%对19.8%，p<0.01）和总住院费用（120590美元对2二十9917美元，p<0.01）。在对基线特征进行调整后，这些结果仍然存在。在亚组分析中，SR的死亡率获益在进行多支血管血运重建的患者中持续存在（在ST段抬高型和非ST段抬高型急性心肌梗死患者中均如此），但在单支血管血运重建患者中不存在。
在患有AMI的患者中，与SR相比，PR与更高的院内全因死亡率相关，但发病率更低、住院时间更短且总住院费用更低。然而，SR的死亡率获益仅在多支血管血运重建中可见，而在单支血管血运重建中未见。
