Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Department of Academic Affairs, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China.
Intern Med J. 2024 Mar;54(3):473-482. doi: 10.1111/imj.16201. Epub 2023 Aug 8.
The clinical effects of multivessel interventions in patients with unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI), multivessel disease (MVD) and chronic kidney disease (CKD) remain uncertain. This study aimed to investigate the safety and effectiveness of intervention in non-culprit lession(s) among this cohort.
We consecutively included patients diagnosed with UA/NSTEMI, MVD and CKD between January 2008 and December 2018 at our centre. After successful percutaneous coronary intervention (PCI), we compared 48-month overall mortality between those undergoing multivessel PCI (MV-PCI) through a single-procedure or staged-procedure approach and culprit vessel-only PCI (CV-PCI) after 1:1 propensity score matching. We conducted stratified analyses and tests for interaction to investigate the modifying effects of critical covariates. Additionally, we recorded the incidence of contrast-induced nephropathy (CIN) to assess the perioperative safety of the two treatment strategies.
Of the 749 eligible patients, 271 pairs were successfully matched. Those undergoing MV-PCI had reduced all-cause mortality (hazard ratio (HR): 0.67, 95% confidence interval (CI): 0.48-0.67). Subgroup analysis showed that those with advanced CKD (estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m ) could not benefit from MV-PCI (P = 0.250), and the survival advantage also tended to diminish in diabetes (P < 0.01; HR = 0.95, 95% CI = 0.65-1.45). Although the staged-procedure approach (N = 157) failed to bring additional survival benefits compared to single-procedure MV-PCI (N = 290) (P = 0.460), it showed a tendency to decrease the death risk. CIN risks in MV-PCI and CV-PCI groups were not significantly different (risk ratio = 1.60, 95% CI = 0.94-2.73).
Among patients with UA/NSTEMI and non-diabetic CKD and an eGFR > 30 mL/min/1.73 m , MV-PCI was associated with a reduced risk of long-term death but did not increase the incidence of CIN during the management of MVD compared to CV-PCI. And staged procedures might be a preferable option over single-procedure MV-PCI.
对于不稳定型心绞痛/非 ST 段抬高型心肌梗死（UA/NSTEMI）、多支血管病变（MVD）和慢性肾脏病（CKD）患者的多支血管介入治疗的临床效果仍不确定。本研究旨在探讨该队列中非罪犯病变介入治疗的安全性和有效性。
我们连续纳入 2008 年 1 月至 2018 年 12 月在我们中心诊断为 UA/NSTEMI、MVD 和 CKD 的患者。在成功进行经皮冠状动脉介入治疗（PCI）后，我们比较了通过单步骤或分阶段方法进行多支血管 PCI（MV-PCI）与仅进行罪犯血管 PCI（CV-PCI）后进行 1:1 倾向评分匹配的 48 个月总体死亡率。我们进行了分层分析和交互检验，以探讨关键协变量的调节作用。此外，我们记录了对比剂肾病（CIN）的发生率，以评估两种治疗策略的围手术期安全性。
在 749 名符合条件的患者中，成功匹配了 271 对。MV-PCI 组全因死亡率降低（风险比（HR）：0.67，95%置信区间（CI）：0.48-0.67）。亚组分析显示，CKD 晚期（估计肾小球滤过率（eGFR）≤30 mL/min/1.73 m ）患者不能从 MV-PCI 中获益（P=0.250），并且糖尿病患者的生存优势也趋于减弱（P < 0.01；HR=0.95，95%CI=0.65-1.45）。虽然分阶段方法（N=157）与单步骤 MV-PCI（N=290）相比未能带来额外的生存获益（P=0.460），但它显示出降低死亡风险的趋势。MV-PCI 和 CV-PCI 组的 CIN 风险无显著差异（风险比=1.60，95%CI=0.94-2.73）。
在 UA/NSTEMI 和非糖尿病 CKD 患者中，eGFR > 30 mL/min/1.73 m ，与 CV-PCI 相比，MV-PCI 与长期死亡风险降低相关，但在 MVD 管理期间不会增加 CIN 的发生率。并且分阶段方法可能优于单步骤 MV-PCI。
