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Background The impact of complete revascularization (CR) on the development of heart failure (HF) in patients with acute coronary syndrome and multivessel coronary artery disease undergoing percutaneous coronary intervention remains to be elucidated. Methods and Results Consecutive patients with acute coronary syndrome with multivessel coronary artery disease from the CORALYS (Incidence and Predictors of Heart Failure After Acute Coronary Syndrome) registry were included. Incidence of first hospitalization for HF or cardiovascular death was the primary end point. Patients were stratified according to completeness of coronary revascularization. Of 14 699 patients in the CORALYS registry, 5054 presented with multivessel disease. One thousand four hundred seventy-three (29.2%) underwent CR, while 3581 (70.8%) did not. Over 5 years follow-up, CR was associated with a reduced incidence of the primary end point (adjusted hazard ratio [HR], 0.66 [95% CI, 0.51-0.85]), first HF hospitalization (adjusted HR, 0.67 [95% CI, 0.49-0.90]) along with all-cause death and cardiovascular death alone (adjusted HR, 0.74 [95% CI, 0.56-0.97] and HR, 0.56 [95% CI, 0.38-0.84], respectively). The results were consistent in the propensity-score matching population and in inverse probability treatment weighting analysis. The benefit of CR was consistent across acute coronary syndrome presentations (HR, 0.59 [95% CI, 0.39-0.89] for ST-segment elevation myocardial infarction and HR, 0.71 [95% CI, 0.50-0.99] for non-ST-elevation acute coronary syndrome) and in patients with left ventricular ejection fraction >40% (HR, 0.52 [95% CI, 0.37-0.72]), while no benefit was observed in patients with left ventricular ejection fraction ≤40% (HR, 0.77 [95% CI, 0.37-1.10], for interaction 0.04). Conclusions CR after acute coronary syndrome reduced the risk of first hospitalization for HF and cardiovascular death, as well as first HF hospitalization, and cardiovascular and overall death both in patients with ST-segment elevation myocardial infarction and non-ST-elevation acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04895176.

背景

经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）伴多支血管病变患者，完全血运重建（CR）对心力衰竭（HF）发展的影响仍待阐明。

方法和结果

连续纳入 CORALYS（ACS 后心力衰竭的发生率和预测因素）注册研究中的 ACS 伴多支血管疾病患者。主要终点为首次因 HF 或心血管死亡住院。根据冠状动脉血运重建的完整性对患者进行分层。在 CORALYS 注册研究的 14699 例患者中，5054 例存在多支血管疾病。1473 例（29.2%）行 CR，3581 例（70.8%）未行。在 5 年随访期间，CR 与降低主要终点（校正风险比 [HR]，0.66 [95% CI，0.51-0.85]）、首次 HF 住院（校正 HR，0.67 [95% CI，0.49-0.90]）及全因死亡和心血管死亡发生率（校正 HR，0.74 [95% CI，0.56-0.97] 和 HR，0.56 [95% CI，0.38-0.84]）相关。倾向评分匹配人群和逆概率治疗加权分析的结果一致。CR 的获益在不同 ACS 表现（ST 段抬高型心肌梗死的 HR 为 0.59 [95% CI，0.39-0.89]，非 ST 段抬高型 ACS 的 HR 为 0.71 [95% CI，0.50-0.99]）和左心室射血分数>40%的患者（HR 为 0.52 [95% CI，0.37-0.72]）中一致，而在左心室射血分数≤40%的患者中无获益（HR 为 0.77 [95% CI，0.37-1.10]，交互检验 P=0.04）。