Culprit Vessel Percutaneous Coronary Intervention Versus Multivessel and Staged Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Patients With Multivessel Disease
Culprit Vessel Percutaneous Coronary Intervention Versus Multivessel and Staged Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Patients With Multivessel Disease
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DOI：
10.1016/j.jcin.2009.10.017
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发表时间：
2010-01-01
影响因子：
11.3
通讯作者：
King, Spencer B., III
中科院分区：
文献类型：
--
作者：
Hannan, Edward L.;Samadashvili, Zaza;King, Spencer B., III
本研究的目的是探讨st段抬高型心肌梗死（STEMI）合并多血管疾病患者接受单血管（罪魁血管）经皮冠状动脉介入治疗（PCI）或多血管PCI治疗后住院和长期死亡率的差异。背景：在药物洗脱支架时代，STEMI和多血管疾病患者的最佳治疗一直备受关注。方法将2003年1月1日至2006年6月30日在纽约接受PCI治疗的STEMI多血管疾病患者分为罪魁祸首血管PCI患者和在指数手术期间、指数入院期间或指数入院后60天内分期接受多血管PCI治疗的患者。对患者进行倾向匹配，并在12、24和42个月时计算死亡率。结果3521例（87.5%）患者在指数手术期间行了罪魁祸首血管PCI。其中259例患者在入院期间接受了分期PCI治疗，538例患者在入院后60天内接受了分期PCI治疗。对于没有血流动力学损害的患者，在指数手术期间，罪魁祸首血管PCI与多血管PCI在指数手术期间的住院死亡率相关（0.9%对2.4%,p = 0.04）。在指数手术后60天内接受分阶段多支PCI治疗的患者12个月死亡率明显低于仅接受罪魁祸首血管PCI治疗的患者（1.3% vs. 3.3%, p = 0.04）。结论：我们的研究结果支持了美国心脏病学会/美国心脏协会（ACC/AHA）的建议，即在患者血流动力学未受损的情况下，对STEMI合并多血管疾病的患者在指数PCI时使用罪魁祸首血管PCI。然而，指数手术后60天内（包括指数入院期间）的分阶段PCI与风险调整死亡率相关，与单独的罪魁祸首血管PCI的死亡率相当。[J] .中华医学会心脏病杂志2010；3:22-31](C) 2010由美国心脏病学会基金会提供
Objectives The purpose of this study was to examine the differences in in-hospital and longer-term mortality for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent single-vessel (culprit vessel) percutaneous coronary interventions (PCIs) or multivessel PCI.Background The optimal treatment of patients with STEMI and multivessel disease is of continuing interest in the era of drug-eluting stents.Methods STEMI patients with multivessel disease undergoing PCIs in New York between January 1, 2003, and June 30, 2006, were subdivided into those who underwent culprit vessel PCI and those who underwent multivessel PCI during the index procedure, during the index admission, or staged within 60 days of the index admission. Patients were propensity-matched and mortality rates were calculated at 12, 24, and 42 months.Results A total of 3,521 patients (87.5%) underwent culprit vessel PCI during the index procedure. A total of 259 of them underwent staged PCI during the index admission and 538 patients underwent staged PCI within 60 days of the index procedure. For patients without hemodynamic compromise, culprit vessel PCI during the index procedure was associated with lower in-hospital mortality than multivessel PCI during the index procedure (0.9% vs. 2.4%, p = 0.04). Patients undergoing staged multivessel PCI within 60 days after the index procedure had a significantly lower 12-month mortality rate than patients undergoing culprit vessel PCI only (1.3% vs. 3.3%, p = 0.04).Conclusions Our findings support the American College of Cardiology/American Heart Association (ACC/AHA) recommendation that culprit vessel PCI be used for STEMI patients with multivessel disease at the time of the index PCI when patients are not hemodynamically compromised. However, staged PCI within 60 days after the index procedure, including during the index admission, is associated with risk-adjusted mortality rates that are comparable with the rate for culprit vessel PCI alone. (J Am Coll Cardiol Intv 2010;3:22-31) (C) 2010 by the American College of Cardiology Foundation