International Clinical Research Center and Department of Cardioangiology, St. Anne University Hospital and Masaryk University, Brno, Czech Republic.
Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
Hellenic J Cardiol. 2024 Mar-Apr;76:1-10. doi: 10.1016/j.hjc.2023.08.009. Epub 2023 Aug 24.
Multivessel primary percutaneous coronary intervention (pPCI) is still often used in patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The study aimed to compare the characteristics and prognosis of patients with CS-STEMI and multivessel coronary disease (MVD) treated with culprit vessel-only pPCI or multivessel-pPCI during the initial procedure.
From 2016 to 2020, 23,703 primary PCI patients with STEMI were included in a national all-comers registry of cardiovascular interventions. Of them, 1,213 (5.1%) patients had CS and MVD at admission to the hospital. Initially, 921 (75.9%) patients were treated with culprit vessel (CV)-pPCI and 292 (24.1%) with multivessel (MV)-pPCI.
Patients with 3-vessel disease and left main disease had a higher probability of being treated with MV-pPCI than patients with 2-vessel disease and patients without left main disease (28.5% vs. 18.6%; p < 0.001 and 37.7% vs. 20.6%; p < 0.001). Intra-aortic balloon pump, extracorporeal membrane oxygenation (ECMO), and other mechanical circulatory support systems were more often used in patients with MV-pPCI. Thirty (30)-day and 1-year all-cause mortality rates were similar in the CV-pPCI and MV-pPCI groups (odds ratio, 1.01; 95% confidence interval [CI] 0.77 to 1.32; p = 0.937 and 1.1; 95% CI 0.84 to 1.44; p = 0.477). The presence of 3-vessel disease and the use of ECMO were the strongest adjusted predictors of 30-day and 1-year mortality.
Our data from an extensive all-comers registry suggests that selective use of MV-pPCI does not increase the all-cause mortality rate in patients with CS-STEMI and MVD compared to CV-pPCI.
多支血管原发性经皮冠状动脉介入治疗（pPCI）在 ST 段抬高型心肌梗死（STEMI）合并心源性休克（CS）患者中仍常被应用。本研究旨在比较 CS-STEMI 合并多支血管病变（MVD）患者接受罪犯血管单纯 pPCI 或初始介入治疗中多支血管 pPCI 的特征和预后。
2016 年至 2020 年，纳入了一项全国心血管介入治疗的所有患者注册研究，共 23703 例 STEMI 患者行急诊 pPCI。其中，1213 例（5.1%）患者入院时合并 CS 和 MVD。最初，921 例（75.9%）患者行罪犯血管（CV）pPCI，292 例（24.1%）患者行多支血管（MV）pPCI。
三支血管病变和左主干病变患者接受 MV-pPCI 的可能性高于两支血管病变和无左主干病变患者（28.5%比 18.6%；p<0.001 和 37.7%比 20.6%；p<0.001）。MV-pPCI 中更常使用主动脉内球囊反搏和体外膜肺氧合（ECMO）等机械循环支持系统。CV-pPCI 组和 MV-pPCI 组 30 天和 1 年全因死亡率相似（比值比，1.01；95%置信区间[CI]0.77 至 1.32；p=0.937 和 1.1；95%CI 0.84 至 1.44；p=0.477）。三支血管病变和 ECMO 的使用是 30 天和 1 年死亡率的最强调整预测因素。
本研究来自广泛的所有患者注册研究，提示与 CV-pPCI 相比，选择性使用 MV-pPCI 不会增加 CS-STEMI 合并 MVD 患者的全因死亡率。
