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Background Complete revascularization reduces cardiovascular events in patients with acute coronary syndromes (ACSs) and multivessel disease. The optimal time point of non-target-vessel percutaneous coronary intervention (PCI) remains a matter of debate. The aim of this study was to investigate the impact of early (<4 weeks) versus late (≥4 weeks) staged PCI of non-target-vessels in patients with ACS scheduled for staged PCI after hospital discharge. Methods and Results All patients with ACS undergoing planned staged PCI from 2009 to 2017 at Bern University Hospital, Switzerland, were analyzed. Patients with cardiogenic shock, in-hospital staged PCI, staged cardiac surgery, and multiple staged PCIs were excluded. The primary end point was all-cause death, recurrent myocardial infarction and urgent premature non-target-vessel PCI. Of 8657 patients with ACS, staged revascularization was planned in 1764 patients, of whom 1432 patients fulfilled the eligibility criteria. At 1 year, there were no significant differences in the crude or adjusted rates of the primary end point (7.8% early versus 10.8% late, hazard ratio [HR], 0.72 [95% CI, 0.47-1.10], =0.129; adjusted HR, 0.80 [95% CI, 0.50-1.28], =0.346) and its individual components (all-cause death: 1.5% versus 2.9%, HR, 0.52 [95% CI, 0.20-1.33], =0.170; adjusted HR, 0.62 [95% CI, 0.23-1.67], =0.343; recurrent myocardial infarction: 4.2% versus 4.4%, HR, 0.97 [95% CI, 0.475-1.10], =0.924; adjusted HR, 1.03 [95% CI, 0.53-2.01], =0.935; non-target-vessel PCI, 3.9% versus 5.7%, HR, 0.97 [95% CI, 0.53-1.80], =0.928; adjusted HR, 1.19 [95% CI, 0.61-2.34], =0.609). Conclusions In this single-center cohort study of patients with ACS scheduled to undergo staged PCI after hospital discharge, early (<4 weeks) versus late (≥4 weeks) staged PCI was associated with a similar rate of major adverse cardiac events at 1 year follow-up. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02241291.

背景

急性冠状动脉综合征（ACS）和多血管疾病患者行完全血运重建可减少心血管事件。非靶血管经皮冠状动脉介入治疗（PCI）的最佳时间点仍存在争议。本研究旨在探讨 ACS 患者出院后行分期 PCI 时，非靶血管早期（<4 周）与晚期（≥4 周）分期 PCI 的影响。

方法和结果

分析了瑞士伯尔尼大学医院 2009 年至 2017 年所有接受计划分期 PCI 的 ACS 患者。排除心源性休克、院内分期 PCI、分期心脏手术和多次分期 PCI 的患者。主要终点为全因死亡、复发性心肌梗死和紧急早期非靶血管 PCI。8657 例 ACS 患者中，1764 例计划行血运重建分期，其中 1432 例符合入选标准。1 年时，主要终点的粗率或调整率无显著差异（早期 7.8%，晚期 10.8%，风险比[HR]，0.72[95%CI，0.47-1.10]，=0.129；调整 HR，0.80[95%CI，0.50-1.28]，=0.346）和其各组成部分（全因死亡：1.5% vs. 2.9%，HR，0.52[95%CI，0.20-1.33]，=0.170；调整 HR，0.62[95%CI，0.23-1.67]，=0.343；复发性心肌梗死：4.2% vs. 4.4%，HR，0.97[95%CI，0.475-1.10]，=0.924；调整 HR，1.03[95%CI，0.53-2.01]，=0.935；非靶血管 PCI：3.9% vs. 5.7%，HR，0.97[95%CI，0.53-1.80]，=0.928；调整 HR，1.19[95%CI，0.61-2.34]，=0.609）。