Routine Angiographic Follow-Up versus Clinical Follow-Up after Percutaneous Coronary Intervention in Acute Myocardial Infarction.
Routine Angiographic Follow-Up versus Clinical Follow-Up after Percutaneous Coronary Intervention in Acute Myocardial Infarction.
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DOI：
10.3349/ymj.2017.58.4.720
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发表时间：
2017-07
影响因子：
2.4
通讯作者：
Oh DJ
中科院分区：
文献类型：
--
作者：
Kim YH;Her AY;Rha SW;Choi BG;Shim M;Choi SY;Byun JK;Li H;Kim W;Kang JH;Choi JY;Park EJ;Park SH;Lee S;Na JO;Choi CU;Lim HE;Kim EJ;Park CG;Seo HS;Oh DJ
急性心肌梗死（AMI）经皮冠状动脉介入治疗（PCI）后常规血管造影随访（RAF）和临床随访（CF）的效用差异尚不清楚。本研究旨在比较接受药物洗脱支架（DES）PCI的AMI患者中RAF和CF的3年临床结局。共入组了774例接受DES PCI的连续AMI患者。在首次PCI后6至9个月进行RAF（n=425）。其余患者接受了医学管理和临床随访（n=349）;采集了患者驱动的事件。为了调整任何潜在混杂因素，使用逻辑回归模型进行倾向评分匹配分析，并生成两个倾向匹配组（248对，n=496，C-统计量=0.739）。比较了RAF组和CF组长达3年的累积临床结局。在3年随访期间，血运重建的累积发生率[靶病变血运重建：风险比（HR），2.40; 95%置信区间（CI），1.18-4.85; p=0.015，靶血管血运重建（TVR）：HR，3.33; 95% CI，1.69-6.58; p=0.001，非TVR：HR，5.64; RAF组的主要不良心脏事件（MACE; HR，3.32; 95% CI，1.92-5.73; p<0.001）显著高于CF组。然而，两组之间的3年死亡和心肌梗死发生率没有差异。AMI患者中DES首次PCI后的RAF与血运重建和MACE的发生率增加相关。因此，CF似乎对PCI治疗AMI后的无症状患者是必要的。
Differences in the utility of routine angiographic follow-up (RAF) and clinical follow-up (CF) after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) are not well understood. The present study aimed to compare the 3-year clinical outcomes of RAF and CF in AMI patients who underwent PCI with drug-eluting stents (DES). A total of 774 consecutive AMI patients who underwent PCI with DES were enrolled. RAF was performed at 6 to 9 months after index PCI (n=425). The remaining patients were medically managed and clinically followed (n=349); symptom-driven events were captured. To adjust for any potential confounders, a propensity score matched analysis was performed using a logistic regression model, and two propensity-matched groups (248 pairs, n=496, C-statistic=0.739) were generated. Cumulative clinical outcomes up to 3 years were compared between RAF and CF groups. During the 3-year follow-up period, the cumulative incidences of revascularization [target lesion revascularization: hazard ratio (HR), 2.40; 95% confidence interval (CI), 1.18–4.85; p=0.015, target vessel revascularization (TVR): HR, 3.33; 95% CI, 1.69–6.58; p=0.001, non-TVR: HR, 5.64; 95% CI, 1.90–16.6; p=0.002] and major adverse cardiac events (MACE; HR, 3.32; 95% CI, 1.92–5.73; p<0.001) were significantly higher in the RAF group than the CF group. However, the 3-year incidences of death and myocardial infarction were not different between the two groups. RAF following index PCI with DES in AMI patients was associated with increased incidences of revascularization and MACE. Therefore, CF seems warranted for asymptomatic patients after PCI for AMI.