Division of Cardiology Christus Good Shepherd Medical Center Longview TX USA.
Texas A&M School of Medicine Bryan TX USA.
J Am Heart Assoc. 2024 Nov 5;13(21):e035535. doi: 10.1161/JAHA.124.035535. Epub 2024 Oct 29.
The comparative outcomes with immediate, staged in-hospital, and staged out-of-hospital complete revascularization for patients with ST-segment-elevation myocardial infarction and multivessel disease remain unclear.
An electronic search of MEDLINE, SCOPUS, and Cochrane databases was performed through August 2023 for randomized trials evaluating immediate, staged in-hospital, and staged out-of-hospital complete revascularization for patients with ST-segment-elevation myocardial infarction and multivessel disease. The primary outcome was major adverse cardiac events (MACEs). The final analysis included 9 trials with 4270 patients. The weighted follow-up duration was 13.8 months. On pairwise meta-analysis, there were no statistically significant differences between immediate versus staged nonculprit percutaneous coronary intervention (PCI) in MACEs (odds ratio, 0.79 [95% CI, 0.54-1.16]). Network meta-analysis showed that there was no statistically significant difference in MACEs with staged in-hospital nonculprit PCI (odds ratio, 1.29-[95% CI, 0.91-1.82]) compared with immediate nonculprit PCI, while there were higher odds of MACEs with out-of-hospital nonculprit PCI (odds ratio, 1.67-[95% CI, 1.21-2.30]) compared with immediate nonculprit PCI. Compared with immediate nonculprit PCI, there were higher odds of ischemia-driven repeat revascularization with staged out-of-hospital nonculprit PCI (odds ratio, 2.26-[95% CI, 1.37-3.72]), but not with in-hospital staged nonculprit PCI. There were no significant differences for the other outcomes among the 3 strategies.
Among patients with ST-segment-elevation myocardial infarction with multivessel disease, an immediate nonculprit PCI approach was associated with similar clinical outcomes to the staged nonculprit PCI approach. The staged out-of-hospital nonculprit PCI approach was associated with a higher incidence of MACEs compared with the other strategies, which was driven by higher risk for ischemia-driven repeat revascularization.
对于 ST 段抬高型心肌梗死合并多支血管病变的患者，即刻、分期院内和分期院外完全血运重建的对比结局尚不清楚。
通过电子检索 MEDLINE、SCOPUS 和 Cochrane 数据库，检索了截至 2023 年 8 月评估 ST 段抬高型心肌梗死合并多支血管病变患者即刻、分期院内和分期院外完全血运重建的随机试验。主要结局为主要不良心脏事件（MACEs）。最终分析纳入了 9 项试验共 4270 例患者。加权随访时间为 13.8 个月。在成对荟萃分析中，即刻与分期非罪犯经皮冠状动脉介入治疗（PCI）在 MACEs 方面无统计学差异（比值比，0.79[95%可信区间，0.54-1.16]）。网络荟萃分析显示，分期院内非罪犯 PCI 与即刻非罪犯 PCI 相比，MACEs 无统计学差异（比值比，1.29-[95%可信区间，0.91-1.82]），而院外非罪犯 PCI 的 MACEs 发生率更高（比值比，1.67-[95%可信区间，1.21-2.30]）。与即刻非罪犯 PCI 相比，分期院外非罪犯 PCI 发生缺血驱动的再次血运重建的可能性更高（比值比，2.26-[95%可信区间，1.37-3.72]），而分期院内非罪犯 PCI 则不然。在这 3 种策略中，其他结局无显著差异。
对于 ST 段抬高型心肌梗死合并多支血管病变的患者，即刻非罪犯 PCI 策略与分期非罪犯 PCI 策略的临床结局相似。与其他策略相比，分期院外非罪犯 PCI 策略的 MACEs 发生率更高，这主要归因于缺血驱动的再次血运重建风险更高。
