Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea.
Division of Cardiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea.
PLoS One. 2021 Oct 13;16(10):e0258525. doi: 10.1371/journal.pone.0258525. eCollection 2021.
A substantial number of patients presenting with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) have severe left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction (LVEF) less than 35%). But data are lacking regarding optimal percutaneous coronary intervention (PCI) strategy for these patients. The aim of this study was to compare the long-term outcomes of IRA (infarct-related artery)-only and multivessel PCI in patients with NSTEMI and MVD complicated by severe LVSD.
Among 13,104 patients enrolled in the PCI registry from November 2011 to December 2015, patients with NSTEMI and MVD with severe LVSD who underwent successful PCI were screened. The primary outcome was 3-year major adverse cardiovascular events (MACEs), defined as all-cause death, any myocardial infarction, stroke, and any revascularization.
Overall, 228 patients were treated with IRA-only PCI (n = 104) or MV-PCI (n = 124). The MACE risk was significantly lower in the MV-PCI group than in the IRA-only PCI group (35.5% vs. 54.8%; hazard ratio [HR] 0.561; 95% confidence interval [CI] 0.378-0.832; p = 0.04). This result was mainly driven by a significantly lower risk of all-cause death (23.4% vs. 41.4%; hazard ratio [HR] 0.503; 95% confidence interval [CI] 0.314-0.806; p = 0.004). The results were consistent after multivariate regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences.
Among patients with NSTEMI and MVD complicated with severe LVSD, multivessel PCI was associated with a significantly lower MACE risk. The findings may provide valuable information to physicians who are involved in decision-making for these patients.
大量表现为非 ST 段抬高型心肌梗死（NSTEMI）和多血管病变（MVD）的患者存在严重左心室收缩功能障碍（LVSD）（左心室射血分数（LVEF）<35%）。但是，关于这些患者的最佳经皮冠状动脉介入治疗（PCI）策略的数据尚缺乏。本研究旨在比较 IRA（梗死相关动脉）单血管 PCI 和多血管 PCI 治疗 NSTEMI 和 MVD 合并严重 LVSD 患者的长期结果。
在 2011 年 11 月至 2015 年 12 月期间的 PCI 注册研究中，筛选出接受成功 PCI 治疗的 NSTEMI 和 MVD 合并严重 LVSD 的患者。主要终点为 3 年主要不良心血管事件（MACEs），定义为全因死亡、任何心肌梗死、卒中和任何血运重建。
共有 228 例患者接受 IRA 单血管 PCI（n = 104）或 MV-PCI（n = 124）治疗。MV-PCI 组的 MACE 风险明显低于 IRA 单血管 PCI 组（35.5% vs. 54.8%；风险比[HR]0.561；95%置信区间[CI]0.378-0.832；p = 0.04）。这一结果主要归因于全因死亡率显著降低（23.4% vs. 41.4%；风险比[HR]0.503；95%置信区间[CI]0.314-0.806；p = 0.004）。在多变量回归、倾向评分匹配和逆概率加权调整基线差异后，结果仍然一致。
在 NSTEMI 和 MVD 合并严重 LVSD 的患者中，多血管 PCI 与 MACE 风险显著降低相关。这些发现可能为参与这些患者决策的医生提供有价值的信息。
