Chen Tingting, Lu Chen, Mo Jingli, Wang Ting, Li Xiang, Yang Ying
Department of Cardiology, School of Clinical Medicine, Dali University, Yunnan Province, China.
Department of Cardiology, The First Affiliated Hospital of Dali University, Yunnan Province, China.
Postepy Kardiol Interwencyjnej. 2024 Dec;20(4):382-392. doi: 10.5114/aic.2024.144666. Epub 2024 Nov 5.
The optimal timing of revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) with multivessel disease (MVD) remains controversial.
We investigated the impact of different revascularization strategies on clinical outcomes to assess the optimal revascularization strategy for these patients.
We performed a network meta-analysis of cohort studies comparing revascularization strategies in NSTEMI with MVD. Effect sizes were calculated as odds ratios (ORs) using a random-effects model. The primary efficacy outcome was all-cause mortality and the primary safety outcome was recurrent myocardial infarction.
Eight eligible studies involving 34,151 patients receiving four revascularization strategies were analyzed. Compared to conventional culprit-only revascularization (COR), planned complete multi-vessel percutaneous coronary intervention during a second hospitalization (MV-PCI) reduced the risk of major adverse cardiovascular events (MACEs) (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.38-0.74) and decreased all-cause mortality (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.30-0.93) and the likelihood of repeat revascularization (MV-PCI vs. COR: OR = 0.55; 95% CI: 0.37-0.82). However, compared to COR, immediate complete revascularization (ICR) but not MV-PCI was associated with reduced risk of recurrent MI (COR vs. ICR: OR = 1.39; 95% CI: 1.07-1.81; MV-PCI vs. COR: OR = 0.64; 95% CI: 0.40-1.01). Compared to MV-PCI: COR and staged complete revascularization during index PCI (SCR) increased the risk of cardiovascular mortality (MV-PCI vs. COR: OR = 0.48; 95% CI: 0.34-0.70; MV-PCI vs. SCR: OR = 0.62; 95% CI: 0.40-0.96). COR also had significantly higher cardiovascular mortality compared to ICR (COR vs. ICR: OR = 1.38; 95% CI: 1.02-1.85).
Complete revascularization is more effective compared to culprit-only revascularization for most follow-ups.
多支血管病变（MVD）的非ST段抬高型心肌梗死（NSTEMI）患者血运重建的最佳时机仍存在争议。
我们研究了不同血运重建策略对临床结局的影响，以评估这些患者的最佳血运重建策略。
我们对比较NSTEMI合并MVD患者血运重建策略的队列研究进行了网状Meta分析。使用随机效应模型将效应大小计算为比值比（OR）。主要疗效结局是全因死亡率，主要安全性结局是复发性心肌梗死。
分析了八项符合条件的研究，涉及34151例接受四种血运重建策略的患者。与仅对罪犯血管进行传统血运重建（COR）相比，在第二次住院期间计划进行完全多支血管经皮冠状动脉介入治疗（MV-PCI）可降低主要不良心血管事件（MACE）的风险（MV-PCI与COR：OR = 0.53；95%CI：0.38 - 0.74），并降低全因死亡率（MV-PCI与COR：OR = 0.53；95%CI：0.30 - 0.93）以及再次血运重建的可能性（MV-PCI与COR：OR = 0.55；95%CI：0.37 - 0.82）。然而，与COR相比，即刻完全血运重建（ICR）而非MV-PCI与复发性心肌梗死风险降低相关（COR与ICR：OR = 1.39；95%CI：1.07 - 1.81；MV-PCI与COR：OR = 0.64；95%CI：0.40 - 1.01）。与MV-PCI相比：COR和在首次PCI期间分期进行完全血运重建（SCR）增加了心血管死亡率的风险（MV-PCI与COR：OR = 0.48；95%CI：0.34 - 0.70；MV-PCI与SCR：OR = 0.62；95%CI：0.40 - 0.96）。COR与ICR相比心血管死亡率也显著更高（COR与ICR：OR = 1.38；95%CI：1.02 - 1.85）。
在大多数随访中，完全血运重建比仅对罪犯血管进行血运重建更有效。
