In-hospital and long-term outcomes of multivessel percutaneous coronary revascularization after acute myocardial infarction
In-hospital and long-term outcomes of multivessel percutaneous coronary revascularization after acute myocardial infarction
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DOI：
10.1016/j.amjcard.2004.09.032
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发表时间：
2005-02-01
影响因子：
2.8
通讯作者：
Rihal, CS
中科院分区：
文献类型：
--
作者：
Chen, LY;Lennon, RJ;Rihal, CS
急性心肌梗死（AMI）后早期多血管经皮冠状动脉介入治疗（PCI）是不提倡的，因为可能增加并发症。然而，随着PCI的最新进展，多血管PCI的安全性和长期结果尚不清楚。我们评估AMI后早期多支PCI的结果（st段抬高和非st段抬高AMI）。我们确定了1997年至2002年AMI后7天内所有患有多血管疾病并接受PCI治疗的患者。临床结果比较了接受多血管PCI治疗的患者（n = 239）和单独接受梗死相关动脉治疗的患者（n = 1145）。主要终点是6、12和36个月的累积生存期。次要终点包括同一时间点的死亡率、复发性梗死、冠状动脉搭桥术或靶血管重建术。随访期间有138例死亡，351例出现复合终点。多支PCI组不良预后指标的发生率明显较高。尽管如此，观察到的事件发生率在多支PCI和单支PCI组之间相似。Kaplan-Meier估计多支PCI组的1年生存率为0.91(95%可信区间[CI] 0.87至0.95)，1支PCI组的1年生存率为0.93(95%可信区间[CI] 0.92至0.95)（p = 0.43）。同样，无复发梗死的1年生存率和靶血管重建率在两组之间相似：多支PCI 0.78 （95% CI 0.73至0.84）和一支PCI 0.78 （95% CI 0.75至0.81）。AMI后多支冠状动脉疾病患者行多支PCI与单支PCI相比，与死亡或合并死亡、心肌梗死、冠状动脉搭桥术或靶血管重建术的额外风险无关。(C)2005年由摘录医疗公司。
Multivessel percutaneous coronary intervention (PCI) early after acute myocardial infarction (AMI) is discouraged because of the potential for increased complications. However, with recent advances in PCI, the safety and long-term outcomes of multivessel PCI are unknown. We evaluated the outcomes of multivessel PCI early after AMI (ST-elevation and non-ST-elevation AMI). We identified all patients who had multivessel disease and underwent PCI within 7 days after an AMI from 1997 to 2002. Clinical outcomes were compared between patients who underwent multivessel PCI (n = 239) and patients who underwent treatment of the infarct-related artery alone (n = 1,145). The primary end point was cumulative survival at 6, 12, and 36 months. Secondary end points included a composite of mortality, recurrent infarction, coronary artery bypass graft, or target vessel revascularization at the same time points. There were 138 deaths and 351 occurrences of the composite end point during follow-up. The multivessel PCI group had a significantly higher prevalence of adverse prognostic indicators. Despite this, observed event rates were similar between the multivessel PCI and 1-vessel PCI groups. The Kaplan-Meier estimated I-year survival was 0.91 (95% confidence interval [CI] 0.87 to 0.95) for the multivessel PCI group and 0.93 (95% Cl 0.92 to 0.95) for the I-vessel PCI group (p = 0.43). Similarly, 1-year survival free of recurrent infarction and target vessel revascularization rates were similar between the 2 groups: multivessel PCI 0.78 (95% CI 0.73 to 0.84) and I-vessel PCI 0.78 (95% CI 0.75 to 0.81). Multivessel PCI in patients with multivessel coronary artery disease after AMI compared with 1-vessel PCI was not associated with an excess risk of death or of combined death, myocardial infarction, coronary artery bypass graft, or target vessel revascularization. (C)2005 by Excerpta Medica Inc.