Pustjens Tobias F S, Timmermans Marijke J C, Rasoul Saman, van 't Hof Arnoud W J
Department of Cardiology, Zuyderland Medical Centre, 6419 PC Heerlen, The Netherlands.
Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
J Clin Med. 2022 Oct 18;11(20):6144. doi: 10.3390/jcm11206144.
Background: There is uncertainty whether multivessel (MV-PCI) or culprit-only percutaneous coronary intervention (CO-PCI) should be the treatment of choice in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD). Aims: To evaluate clinical characteristics and outcomes in these patients undergoing MV-PCI or CO-PCI at the index procedure. Methods: Data were retrieved from the nationwide Netherlands Heart Registration. All NSTE-ACS patients with MVD undergoing PCI between 1 January 2017 and 1 October 2019 were grouped into a MV-PCI or CO-PCI group. The primary endpoint was all-cause mortality at long-term follow-up (median 756 days (593−996)). Secondary endpoints were reinterventions, urgent CABG, myocardial infarction (MI) < 30 days, target vessel revascularisation (TVR) and mortality at 1 year. Propensity score matching analyses were performed. Results: In total, 10,507 NSTE-ACS patients with MVD were included into the MV-PCI (N = 4235) and CO-PCI group (N = 6272). Analysing crude data, mortality rates at long-term follow-up (10.7% vs. 10.2%; p = 0.383), mortality at 1 year (6.0% vs. 5.6%; p = 0.412) and MI <30 days (0.8% vs. 0.9%; p = 0.513) were similar between both groups. Reinterventions (11.1% vs. 20.0%; p < 0.001), urgent CABG (0.1% vs. 0.4%; p = 0.001) and TVR (5.2% vs. 6.7%; p = 0.003) occurred less often in the MV-PCI group. Survival analysis after multiple imputation and propensity score matching showed similar mortality rates at long-term follow-up (log-rank p = 0.289), but a significant reduction for reinterventions in the MV-PCI group (log-rank p < 0.001). Conclusion: NSTE-ACS patients with MVD undergoing MV-PCI have similar mortality rates at long-term follow-up compared to CO-PCI. However, improved event-free survival in terms of fewer coronary reinterventions was observed.
对于非ST段抬高型急性冠状动脉综合征（NSTE-ACS）合并多支血管病变（MVD）的患者，多支血管经皮冠状动脉介入治疗（MV-PCI）或仅对罪犯血管进行经皮冠状动脉介入治疗（CO-PCI）是否应作为首选治疗方法尚不确定。目的：评估这些患者在首次手术时接受MV-PCI或CO-PCI的临床特征和结局。方法：数据取自全国性的荷兰心脏注册研究。2017年1月1日至2019年10月1日期间所有接受PCI的NSTE-ACS合并MVD患者被分为MV-PCI组或CO-PCI组。主要终点是长期随访（中位时间756天（593 - 996天））时的全因死亡率。次要终点是再次干预、急诊冠状动脉旁路移植术（CABG）、30天内心肌梗死（MI）、靶血管血运重建（TVR）和1年时的死亡率。进行倾向评分匹配分析。结果：总共10507例NSTE-ACS合并MVD患者被纳入MV-PCI组（N = 4235）和CO-PCI组（N = 6272）。分析原始数据，两组长期随访时的死亡率（10.7%对10.2%；p = 0.383）、1年时的死亡率（6.0%对5.6%；p = 0.412）和30天内MI发生率（0.8%对0.9%；p = 0.513）相似。MV-PCI组的再次干预（11.1%对20.0%；p < 0.001）、急诊CABG（0.1%对0.4%；p = 0.001）和TVR（5.2%对6.7%；p = 0.003）发生率较低。多次插补和倾向评分匹配后的生存分析显示，长期随访时死亡率相似（对数秩检验p = 0.289），但MV-PCI组再次干预显著减少（对数秩检验p < 0.001）。结论：与CO-PCI相比，接受MV-PCI的NSTE-ACS合并MVD患者长期随访时死亡率相似。然而，观察到在冠状动脉再次干预次数较少方面无事件生存期有所改善。
