Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium.
EuroIntervention. 2024 Jul 15;20(14):e865-e875. doi: 10.4244/EIJ-D-23-00882.
Complete revascularisation is supported by recent trials in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD) without cardiogenic shock. However, the optimal timing of non-culprit lesion revascularisation is currently debated.
This prespecified analysis of the BioVasc trial aims to determine the effect of immediate complete revascularisation (ICR) compared to staged complete revascularisation (SCR) on clinical outcomes in patients with STEMI.
Patients presenting with STEMI and MVD were randomly assigned to ICR or SCR. The primary endpoint was the composite of all-cause mortality, myocardial infarction, any unplanned ischaemia-driven revascularisation, or cerebrovascular events at 1-year post-index procedure.
Between June 2018 and October 2021, 608 (ICR: 305, SCR: 303) STEMI patients were enrolled. No significant differences between ICR and SCR were observed at 1-year follow-up in terms of the primary endpoint (7.0% vs 8.3%, hazard ratio [HR] 0.84, 95% confidence interval [CI]: 0.47-1.50; p=0.55): all-cause mortality (2.3% vs 1.3%, HR 1.77, 95% CI: 0.52-6.04; p=0.36), myocardial infarction (1.7% vs 3.3%, HR 0.50, 95% CI: 0.17-1.47; p=0.21), unplanned ischaemia-driven revascularisation (4.1% vs 5.0%, HR 0.80, 95% CI: 0.38-1.71; p=0.57) and cerebrovascular events (1.4% vs 1.3%, HR 1.01, 95% CI: 0.25-4.03; p=0.99). At 30-day follow-up, a trend towards a reduction of the primary endpoint in the ICR group was observed (ICR: 3.0% vs SCR: 6.0%, HR 0.50, 95% CI: 0.22-1.11; p=0.09). ICR was associated with a reduction in overall hospital stay (ICR: median 3 [interquartile range {IQR} 2-5] days vs SCR: median 4 [IQR 3-6] days; p<0.001).
Clinical outcomes at 1 year were similar for STEMI patients who had undergone ICR and those who had undergone SCR.
最近的试验支持 ST 段抬高型心肌梗死（STEMI）和多支血管病变（MVD）且无心源性休克患者进行完全血运重建。然而，目前对于非罪犯病变血运重建的最佳时机仍存在争议。
本研究旨在探讨即刻完全血运重建（ICR）与分期完全血运重建（SCR）在 STEMI 患者中的临床结局。
本研究是 BioVasc 试验的预设分析，将 STEMI 合并 MVD 的患者随机分为 ICR 或 SCR 组。主要终点为索引操作后 1 年时全因死亡率、心肌梗死、任何非计划性缺血驱动的血运重建或脑血管事件的复合终点。
2018 年 6 月至 2021 年 10 月，共纳入 608 例 STEMI 患者（ICR：305 例，SCR：303 例）。1 年随访时，ICR 组与 SCR 组在主要终点方面无显著差异（7.0% vs 8.3%，风险比[HR]0.84，95%置信区间[CI]：0.47-1.50；p=0.55）：全因死亡率（2.3% vs 1.3%，HR 1.77，95%CI：0.52-6.04；p=0.36）、心肌梗死（1.7% vs 3.3%，HR 0.50，95%CI：0.17-1.47；p=0.21）、非计划性缺血驱动的血运重建（4.1% vs 5.0%，HR 0.80，95%CI：0.38-1.71；p=0.57）和脑血管事件（1.4% vs 1.3%，HR 1.01，95%CI：0.25-4.03；p=0.99）。在 30 天随访时，ICR 组的主要终点有降低的趋势（ICR：3.0% vs SCR：6.0%，HR 0.50，95%CI：0.22-1.11；p=0.09）。ICR 与总住院时间的缩短相关（ICR：中位数 3 天[四分位距 {IQR} 2-5] vs SCR：中位数 4 天[IQR 3-6]；p<0.001）。
在 STEMI 患者中，即刻完全血运重建和分期完全血运重建的 1 年临床结局相似。
