Multivessel vs culprit-only percutaneous coronary intervention among patients 65 years or older with acute myocardial infarction
Multivessel vs culprit-only percutaneous coronary intervention among patients 65 years or older with acute myocardial infarction
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DOI：
10.1016/j.ahj.2015.10.017
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发表时间：
2016-02-01
影响因子：
4.8
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
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作者：
Wang, Tracy Y.;Mccoy, Lisa A.;Peterson, Eric D.
老年急性心肌梗死（MI）患者通常有多支冠状动脉疾病，适合经皮冠状动脉介入治疗（PCI），但多支介入治疗的风险可能超过这些患者的潜在益处。我们试图确定指数PCI期间的非罪犯干预是否与老年急性心肌梗死和多支血管疾病患者的更好结局相关。方法我们检查了19，271例ST段抬高型心肌梗死（STEMI）和31，361例非STEMI（NSTEMI）65岁或以上的多支血管疾病患者，在一个链接的CathPCI注册医疗保险数据库中，排除了既往冠状动脉旁路移植术的患者，左主干疾病或心源性休克使用逆概率加权倾向调整，我们比较了在指数PCI手术期间接受仅罪魁祸首干预与多支血管干预的患者之间的死亡率。结果大多数老年MI患者（91%的STEMI和74%的NSTEMI）在指数PCI期间接受了仅罪魁祸首干预。在STEMI患者中，首次PCI期间多支血管干预与仅罪魁祸首干预相比，30天死亡率更高（8.3% vs 6.3%，调整后风险比[HR] 1.36，95%CI 1.14-1.62），并且这种趋势持续到1年（13.8% vs 12.2%，调整后HR 1.14，95%CI 0.99-1.31）。NSTEMI患者在30天时的死亡率无显著差异（3.4% vs 4.1%，校正HR 1.01，95% CI 0.88-1.15）或1年时（10.1% vs 10.8%，校正HR 0.99，95%CI 0.91-1.08）。结论STEMI患者首次PCI期间的非罪犯干预与不良结局相关，而非NSTEMI患者。
Background Older adults presenting with acute myocardial infarction (MI) often have multivessel coronary artery disease amenable to percutaneous coronary intervention (PCI), yet the risks of multivessel intervention may outweigh potential benefits in these patients. We sought to determine if nonculprit intervention during the index PCI is associated with better outcomes among older patients with acute MI and multivessel disease.Methods We examined 19,271 ST-segment elevation MI (STEMI) and 31,361 non-STEMI (NSTEMI) patients 65 years or older with multivessel disease in a linked CathPCI Registry-Medicare database, excluding patients with prior coronary artery bypass grafting, left main disease, or cardiogenic shock. Using inverse probability-weighted propensity adjustment, we compared mortality between patients receiving culprit-only vs multivessel intervention during the index PCI procedure.Results Most older MI patients (91% STEMI and 74% NSTEMI) received culprit-only intervention during the index PCI. Among STEMI patients, multivessel intervention during the index PCI was associated with higher 30-day mortality (8.3% vs 6.3%, adjusted hazard ratio [HR] 1.36, 95% CI 1.14-1.62) than culprit-only intervention, and this trend persisted at 1 year (13.8% vs 12.2%, adjusted HR 1.14, 95% CI 0.99-1.31). No significantmortality differences were observed among NSTEMI patients at 30 days (3.4% vs 4.1%, adjusted HR 1.01, 95% CI 0.88-1.15) or at 1 year (10.1% vs 10.8%, adjusted HR 0.99, 95% CI 0.91-1.08).Conclusions Nonculprit intervention during the index PCI was associated with worse outcomes among STEMI patients, but not NSTEMI patients.