Sucato Vincenzo, Madaudo Cristina, Marotta Antonia, Ortello Antonella, Camarda Emmanuele Antonio, Comparato Francesco, Galassi Alfredo Ruggero
Division of Cardiology, Department of Excellence of Sciences for Health Promotion and Mother and Child Care, Internal Medicine and Specialties (ProMISE), University Hospital Paolo Giaccone, University of Palermo, Via Del Vespro n° 129, 90127 Palermo, Italy.
J Clin Med. 2024 Aug 27;13(17):5070. doi: 10.3390/jcm13175070.
There are many questions regarding the optimal approach to treating non-culprit lesions in STEMI patients. Several questions still need to be answered, such as identifying the lesions to be revascularized and the optimal timing. We conducted a single-center analysis. The primary outcome was the incidence of major cardiovascular and cerebral adverse events (MACCE) at 12 months in patients with STEMI and multivessel disease (MVD) who achieved complete revascularization during the index procedure or with a staged procedure. The secondary outcomes were death from any cause, myocardial infarction, target lesion revascularization, stroke, major bleeding events, new angina episodes, new hospitalization, and in-hospital MACCE. From January 2021 to December 2022, a total of 230 patients with STEMI underwent primary PCI in our department; 87 patients had MVD. Fifty-nine patients (67.8%) underwent a non-culprit revascularization strategy during the index procedure strategy, and 28 patients (32.2%) during a staged procedure. The incidence of MACCE at 12 months was 11.9% (seven patients) in the index PCI group, compared with 32.1% (nine patients) in the staged PCI group (odds ratio, 3.52; 95% CI, 1.15 to 10.77; = 0.022). In-hospital MACCE occurred in five patients (8.5%) of the index PCI group, compared with seven patients (25%) in the staged PCI group (odds ratio, 3.60; 95% CI, 1.03 to 12.61; = 0.036). A trend towards better outcomes favoring the index PCI group was observed with death from any cause, myocardial infarction, target lesion revascularization, and new angina episodes. Better outcomes were evident with an index PCI strategy than with a staged PCI strategy for complete revascularization in patients with STEMI and MVD.
关于ST段抬高型心肌梗死（STEMI）患者非罪犯病变的最佳治疗方法存在许多问题。仍有几个问题需要回答，例如确定需要进行血运重建的病变以及最佳时机。我们进行了一项单中心分析。主要结局是在首次手术或分期手术中实现完全血运重建的STEMI合并多支血管病变（MVD）患者12个月时主要心血管和脑部不良事件（MACCE）的发生率。次要结局包括任何原因导致的死亡、心肌梗死、靶病变血运重建、中风、大出血事件、新发心绞痛发作、再次住院以及院内MACCE。2021年1月至2022年12月，我院共有230例STEMI患者接受了直接经皮冠状动脉介入治疗（PCI）；87例患者患有MVD。59例患者（67.8%）在首次手术策略期间接受了非罪犯血管血运重建策略，28例患者（32.2%）在分期手术期间接受了该策略。首次PCI组12个月时MACCE的发生率为11.9%（7例患者），而分期PCI组为32.1%（9例患者）（优势比，3.52；95%置信区间，1.15至10.77；P = 0.022）。首次PCI组有5例患者（8.5%）发生院内MACCE，而分期PCI组有7例患者（25%）发生（优势比，3.60；95%置信区间，1.03至12.61；P = 0.036）。在任何原因导致的死亡、心肌梗死、靶病变血运重建和新发心绞痛发作方面，观察到有利于首次PCI组的更好结局趋势。对于STEMI合并MVD患者的完全血运重建，首次PCI策略比分期PCI策略具有更明显的更好结局。
