Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland.
Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland.
Am J Cardiol. 2024 Dec 1;232:49-56. doi: 10.1016/j.amjcard.2024.09.013. Epub 2024 Sep 18.
Whether physiology-guided complete revascularization of nonculprit lesions is superior to culprit lesion-only percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI) and multivessel disease remains debated. Online databases were searched for randomized controlled trials comparing physiology-guided complete revascularization and culprit lesion-only PCI in patients with MI. The outcomes of interest were all-cause death, cardiovascular (CV) death, repeat revascularization, MI, stent thrombosis, and contrast-associated nephropathy/acute kidney injury. Pooled odds ratios, along with 95% confidence intervals (CI) were calculated. A total of 4,849 patients (n = 2,288 physiology-guided complete revascularization, n = 2,561 culprit lesion-only PCI) were included. The mean age was 66 years and 76% were men. At a mean follow-up of 2.5 years, physiology-guided complete revascularization was associated with significant reductions in CV death (odds ratio 0.72, 95% CI 0.54 to 0.97, p = 0.03) and repeat revascularizations (0.50, 95% CI 0.38 to 0.66, p <0.00001) compared with culprit lesion-only PCI. There were no differences between the 2 approaches in all-cause death (0.91, 95% CI 0.69 to 1.19, p = 0.50), MI (0.85, 95% CI 0.59 to 1.21, p = 0.36), stent thrombosis (1.24, 95% CI 0.58 to 2.69, p = 0.58), and contrast-associated nephropathy/acute kidney injury (1.07, 95% CI 0.88 to 1.31, p = 0.50). In conclusion, among patients with MI and multivessel disease, physiology-guided complete revascularization was associated with significant reductions in CV death and revascularizations compared with culprit lesion-only PCI.
在患有心肌梗死 (MI) 和多支血管疾病的患者中，非罪犯病变的生理学指导下完全血运重建是否优于罪犯病变的单纯经皮冠状动脉介入治疗 (PCI) 仍存在争议。在线数据库中搜索了比较生理学指导下完全血运重建和 MI 患者罪犯病变单纯 PCI 的随机对照试验。感兴趣的结局包括全因死亡、心血管 (CV) 死亡、再次血运重建、MI、支架血栓形成和造影剂相关肾病/急性肾损伤。计算了汇总优势比 (OR) 及其 95%置信区间 (CI)。共纳入 4849 例患者 (n = 2288 例生理学指导下完全血运重建，n = 2561 例罪犯病变单纯 PCI)。平均年龄为 66 岁，76%为男性。平均随访 2.5 年后，与罪犯病变单纯 PCI 相比，生理学指导下完全血运重建与 CV 死亡 (OR 0.72，95%CI 0.54 至 0.97，p = 0.03) 和再次血运重建 (0.50，95%CI 0.38 至 0.66，p <0.00001) 显著降低相关。两种方法在全因死亡 (0.91，95%CI 0.69 至 1.19，p = 0.50)、MI (0.85，95%CI 0.59 至 1.21，p = 0.36)、支架血栓形成 (1.24，95%CI 0.58 至 2.69，p = 0.58) 和造影剂相关肾病/急性肾损伤 (1.07，95%CI 0.88 至 1.31，p = 0.50) 方面无差异。总之，在患有 MI 和多支血管疾病的患者中，与罪犯病变单纯 PCI 相比，生理学指导下完全血运重建与 CV 死亡和血运重建的显著降低相关。
