Oktaviono Yudi Her, Arnindita Jannatin Nisa, Saputra Pandit Bagus Tri, Wairooy Nabilah Azzah Putri, Damayanti Arlia Ayu, Hutomo Suryo Ardi, Pratama Nando Reza, Al Farabi Makhyan Jibril, Ashari Faisal Yusuf
Department of Cardiology and Vascular Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
PLoS One. 2025 Mar 18;20(3):e0310695. doi: 10.1371/journal.pone.0310695. eCollection 2025.
Percutaneous coronary intervention (PCI) is a revolutionary breakthrough in saving many lives from myocardial infarction. However, little is known about the PCI strategy in multivessel disease (MVD) Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients. Should complete revascularization be achieved or culprit-only is sufficient, then when the appropriate time of multivessel revascularization is, whether it is staged or immediate. Limited evidence is available on this matter compared to ST-elevation myocardial infarction (STEMI), even though NSTE-ACS patients carry poorer long-term prognoses compared to STEMI.
A thorough search for appropriate studies was executed across PubMed, Embase, Medline, Science Direct, and Scopus databases until July 4th, 2023. The risk ratio (RR) underwent analysis through Review Manager 5.4.
Twenty-six studies with 222,350 MVD NSTE-ACS patients were included. Culprit-only revascularization was significantly related to a higher risk of non-fatal MI (RR: 1.41, 95% CI: 1.04-1.91, p = 0.03, I2: 65%) and all-repeat revascularization (RR 1.86, 95% CI 1.07-3.25, p = 0.03). While multistage multivessel revascularization was related to significantly higher all-cause mortality (RR: 1.73; 95% CI 1.43-2.10; p < 0.01; I2: 0%), TVR repeat (RR 1.38 95% CI 1.11-1.73, I2 = 18%, p = 0.004), and non-TVR repeat (RR 2.59; 95% CI 1,56-4.30; p = 0.0002; I2: 70%).
Patients with MVD NSTE-ACS treated with multivessel revascularization showed more favorable results than culprit-only. One-stage multivessel revascularization resulted in fewer adverse events than multistage. Additionally, a comprehensive and methodical prospective investigation is required to validate the factors accountable for these outcomes.
经皮冠状动脉介入治疗（PCI）是挽救许多心肌梗死患者生命的一项革命性突破。然而，对于多支血管病变（MVD）非ST段抬高急性冠状动脉综合征（NSTE-ACS）患者的PCI策略，人们了解甚少。是应实现完全血运重建还是仅处理罪犯血管就足够了，那么多支血管血运重建的合适时机是什么时候，是分期进行还是即刻进行。与ST段抬高型心肌梗死（STEMI）相比，关于此事的证据有限，尽管NSTE-ACS患者的长期预后比STEMI患者更差。
在PubMed、Embase、Medline、Science Direct和Scopus数据库中进行全面搜索，直至2023年7月4日。通过Review Manager 5.4对风险比（RR）进行分析。
纳入了26项研究，共222,350例MVD NSTE-ACS患者。仅处理罪犯血管的血运重建与非致命性心肌梗死风险较高显著相关（RR：1.41，95%CI：1.04-1.91，p = 0.03，I²：65%）以及所有再次血运重建（RR 1.86，95%CI 1.07-3.25，p = 0.03）。而分期多支血管血运重建与全因死亡率显著较高相关（RR：1.73；95%CI 1.43-2.10；p < 0.01；I²：0%），靶血管再次血运重建（RR 1.38，95%CI 1.11-1.73，I² = 18%，p = 0.004），以及非靶血管再次血运重建（RR 2.59；95%CI 1.56-4.30；p = 0.0002；I²：70%）。
接受多支血管血运重建治疗的MVD NSTE-ACS患者比仅处理罪犯血管显示出更有利的结果。一期多支血管血运重建比分期进行导致的不良事件更少。此外，需要进行全面且系统的前瞻性研究来验证导致这些结果的因素。
