Culprit-only or multivessel revascularization in patients with acute coronary syndromes: An American College of Cardiology National Cardiovascular Database Registry report
Culprit-only or multivessel revascularization in patients with acute coronary syndromes: An American College of Cardiology National Cardiovascular Database Registry report
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DOI：
10.1016/j.ahj.2007.09.007
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发表时间：
2008-01-01
影响因子：
4.8
通讯作者：
Brindis, Ralph G.
中科院分区：
文献类型：
--
作者：
Brener, Sorin J.;Milford-Beland, Sarah;Brindis, Ralph G.
多支（MV）冠状动脉疾病（CAD）常见于非ST段抬高（NSTE）急性冠状动脉综合征（ACS）患者。尽管早期侵入性策略可改善这些患者的结局，但在NSTE ACS环境中仅进行罪犯、单血管（SV）经皮冠状动脉介入治疗（PCI）或MV PCI的数据有限。方法分析2000年至2004年美国心脏病学会国家心血管数据库登记处报告的402家中心的105866例ACS和MV CAD患者接受PCI的记录，以确定ACS患者SV与MV PCI的预测因素，并比较其出院结局。使用患者的人口统计学、临床和血管造影特征创建SV与MV PCI的倾向评分。结果68%（72048例）行单支血管PCI，32%（33818例）行MV PCI。与SV和MV PCI的表现独立相关的因素是NSTE梗死（与不稳定型心绞痛相比），校正比值比（OR）为1.29（95% CI 1.24-1.34）;年龄较大，校正OR为1.09（95% CI 1.08-1.11）;以及存在完全闭塞，校正OR为1.25（95% CI 1.16-1.36）。模型的c统计量为0.70。SV PCI的手术成功率为91%，MV PCI的手术成功率为88%（P
Background Multivessel (MV) coronary artery disease (CAD) frequently exists in patients presenting with non-ST-elevation (NSTE) acute coronary syndromes (ACSs). Although an early invasive strategy improves outcome in these patients, there are limited data on culprit only, single-vessel (SV) percutaneous coronary intervention (PCI) or MV PCI in the NSTE ACS setting. Methods To identify the predictors of SV versus MV PCI in patients with ACS and compare their outcomes up to hospital discharge, we analyzed the records of 105 866 patients undergoing PCI with ACS and MV CAD from 402 centers reported to the American College of Cardiology National Cardiovascular Database Registry between 2000 and 2004. Demographic, clinical, and angiographic characteristics of the patients were used to create a propensity score for SV versus MV PCI. Results Sing le-vessel PCI was performed in 68% (72048 patients), whereas the remaining 32% (3 3 818 patients) had MV PCI. Factors independently associated with the performance of SV versus MV PCI were presentation with NSTE infarction (vs unstable angina), adjusted odds ratio (OR) of 1.29 (95% CI 1.24-1.34); being older, adjusted OR of 1.09 (95% CI 1.08-1.11) per decade; and presence of total occlusion, adjusted OR of 1.25 (95% CI 1.16-1.36). The c-statistic for the model was 0.70. Procedural success was achieved in 91 % of SV PCI and 88% of MV PCI (P