血管内影像学指导下的急性心肌梗死合并心原性休克患者的经皮冠状动脉介入治疗。

Intravascular imaging-guided percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock.

机构信息

Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.

Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea.

出版信息

Rev Esp Cardiol (Engl Ed). 2024 Dec;77(12):995-1007. doi: 10.1016/j.rec.2024.03.009. Epub 2024 Apr 10.

DOI:10.1016/j.rec.2024.03.009

PMID:38609042

Abstract

INTRODUCTION AND OBJECTIVES

There are no clinical data on the efficacy of intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI in patients with acute myocardial infarction (AMI) and cardiogenic shock. The current study sought to evaluate the impact of intravascular imaging-guided PCI in patients with AMI and cardiogenic shock.

METHODS

Among a total of 28 732 patients from the nationwide pooled registry of KAMIR-NIH (November, 2011 to December, 2015) and KAMIR-V (January, 2016 to June, 2020), we selected a total of 1833 patients (6.4%) with AMI and cardiogenic shock who underwent PCI of the culprit vessel. The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, a composite of cardiac death, myocardial infarction, repeat revascularization, and definite or probable stent thrombosis.

RESULTS

Among the study population, 375 patients (20.5%) underwent intravascular imaging-guided PCI and 1458 patients (79.5%) underwent angiography-guided PCI. Intravascular imaging-guided PCI was associated with a significantly lower risk of 1-year MACE than angiography-guided PCI (19.5% vs 28.2%; HR, 0.59; 95%CI, 0.45-0.77; P<.001), mainly driven by a lower risk of cardiac death (13.7% vs 24.0%; adjusted HR, 0.53; 95%CI, 0.39-0.72; P<.001). These results were consistent in propensity score matching (HR, 0.68; 95%CI, 0.46-0.99), inverse probability weighting (HR, 0.61; 95%CI, 0.45-0.83), and Bayesian analysis (Odds ratio, 0.66, 95% credible interval, 0.49-0.88).

CONCLUSIONS

In AMI patients with cardiogenic shock, intravascular imaging-guided PCI was associated with a lower risk of MACE at 1-year than angiography-guided PCI, mainly driven by the lower risk of cardiac death.

摘要

引言和目的

目前尚无血管内影像学指导的经皮冠状动脉介入治疗（PCI）与血管造影指导的 PCI 在急性心肌梗死（AMI）伴心源性休克患者中的疗效的临床数据。本研究旨在评估血管内影像学指导的 PCI 对 AMI 伴心源性休克患者的影响。

方法

在全国性 KAMIR-NIH（2011 年 11 月至 2015 年 12 月）和 KAMIR-V（2016 年 1 月至 2020 年 6 月）登记研究中，共纳入 28732 例患者，我们从中选择了 1833 例（6.4%）接受罪犯血管 PCI 的 AMI 伴心源性休克患者。主要终点是 1 年时的主要不良心血管事件（MACE），包括心源性死亡、心肌梗死、再次血运重建和明确或可能的支架血栓形成。

结果

在研究人群中，375 例（20.5%）患者接受血管内影像学指导的 PCI，1458 例（79.5%）患者接受血管造影指导的 PCI。与血管造影指导的 PCI 相比，血管内影像学指导的 PCI 1 年 MACE 风险显著降低（19.5% vs. 28.2%；HR，0.59；95%CI，0.45-0.77；P<.001），主要归因于心源性死亡风险降低（13.7% vs. 24.0%；调整后的 HR，0.53；95%CI，0.39-0.72；P<.001）。在倾向评分匹配（HR，0.68；95%CI，0.46-0.99）、逆概率加权（HR，0.61；95%CI，0.45-0.83）和贝叶斯分析（OR，0.66，95%可信区间，0.49-0.88）中也观察到了一致的结果。