Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.
Université de Paris, Paris, France.
Clin Cardiol. 2021 Mar;44(3):429-437. doi: 10.1002/clc.23567. Epub 2021 Feb 14.
ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) are associated with a worse prognosis. However, few comparisons are available according to coronary status in the era of modern reperfusion and optimized secondary prevention.
We hypothesized that the difference in prognosis according to number of vessel disease in STEMI patients has reduced.
All consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptoms onset between January 1, 2014 and June 30, 2016 enrolled in the CRAC (Club Régional des Angioplasticiens de la région Centre) France PCI registry were analyzed. Baseline characteristics, management, and outcomes at 1-year were analyzed according to coronary status (one-, two-, and three-VD).
A total of 1886 patients (mean age 62.2 ± 14.0 year; 74% of male) were included. Patients with MVD (two or three-VD) represented 53.7%. They were older with higher cardiovascular risk factor profile. At 1 year, the rate of major adverse cardiovascular events (MACE, defined as all-cause death, stroke or re-MI) was 10%, 12%, and 12% in one-, two, and three-VD respectively (p = .28). In multivariable adjusted Cox proportional hazard regression model, two- and three-VD were not associated with higher rate of MACE compared to patients with single VD (HR, 1.09; 95%CI 0.76-1.56 for two-VD; HR, 0.74; 95%CI 0.48-1.14 for three-VD).
MVD still represents an important proportion of STEMI patients but their prognoses were not associated with worse clinical outcomes at 1-year compared with one-VD patients in a modern reperfusion area and secondary medication prevention.
ST 段抬高型心肌梗死（STEMI）合并多支血管病变（MVD）患者的预后较差。然而，在现代再灌注和优化二级预防的时代，根据冠状动脉情况进行比较的资料较少。
我们假设 STEMI 患者根据血管病变数量不同，其预后的差异有所缩小。
分析了 2014 年 1 月 1 日至 2016 年 6 月 30 日期间在法国 CRAC（中部地区血管成形术俱乐部）登记处连续登记的发病 24 小时内接受经皮冠状动脉介入治疗（PCI）的所有 STEMI 患者，根据冠状动脉情况（单支、双支和三支血管病变）分析基线特征、治疗和 1 年时的结局。
共纳入 1886 例患者（平均年龄 62.2±14.0 岁，74%为男性），其中 MVD（两支或三支血管病变）患者占 53.7%。这些患者年龄较大，心血管危险因素谱较高。1 年时，单支、双支和三支血管病变患者的主要不良心血管事件（MACE，定义为全因死亡、卒中和再发心肌梗死）发生率分别为 10%、12%和 12%（p=0.28）。多变量调整 Cox 比例风险回归模型显示，与单支血管病变患者相比，双支和三支血管病变患者的 MACE 发生率没有更高（HR，1.09；95%CI 0.76-1.56 为双支血管病变；HR，0.74；95%CI 0.48-1.14 为三支血管病变）。
MVD 仍然是 STEMI 患者的一个重要组成部分，但在现代再灌注和二级药物预防区域，与单支血管病变患者相比，他们的预后在 1 年时与临床结局没有相关性。
