Impact of Multivessel Revascularization on Health Status Outcomes in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

被引：19

作者：

Jang, Jae-Sik ^{[1
,2
,3
]}

Spertus, John A. ^{[1
,2
]}

Arnold, Suzanne V. ^{[1
,2
]}

Shafiq, Ali ^{[1
,2
]}

Grodzinsky, Anna ^{[1
,2
]}

Fendler, Timothy J. ^{[1
,2
]}

Salisbury, Adam C. ^{[1
,2
]}

Tang, Fengming ^{[1
]}

McNulty, Edward J. ^{[4
]}

Grantham, J. Aaron ^{[1
,2
]}

Cohen, David J. ^{[1
,2
]}

Amin, Amit P. ^{[5
,6
]}

机构：

[1] St Lukes Mid Amer Heart Inst, Cardiovasc Outcomes Res, Kansas City, MO 64111 USA

[2] Univ Missouri, Kansas City, MO 64110 USA

[3] Inje Univ, Coll Med, Busan Paik Hosp, Dept Cardiol, Busan, South Korea

[4] Kaiser Permanente Med Ctr, Div Cardiol, San Francisco, CA USA

[5] Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA

[6] Barnes Jewish Hosp, St Louis, MO 63110 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2015年 / 66卷 / 19期

基金：

美国国家卫生研究院; 新加坡国家研究基金会;

关键词：

myocardial infarction; percutaneous coronary intervention; quality of health care; QUALITY-OF-LIFE; SEATTLE ANGINA QUESTIONNAIRE; RANDOMIZED-TRIAL; MEDICAL THERAPY; INTERVENTION; CULPRIT; VESSEL; METAANALYSIS; REPERFUSION; OUTPATIENTS;

D O I：

10.1016/j.jacc.2015.08.873

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Up to 65% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (MVCAD). Long-term health status of STEMI patients after multivessel revascularization is unknown. OBJECTIVES This study investigated the relationship between multivessel revascularization and health status outcomes (symptoms and quality of life [QoL]) in STEMI patients with MVCAD. METHODS Using a U.S. myocardial infarction registry and the Seattle Angina Questionnaire (SAQ), we determined the health status of patients with STEMI and MVCAD at the time of STEMI and 1 year later. We assessed the association of multivessel revascularization during index hospitalization with 1-year health status using multivariable linear regression analysis, and also examined demographic, clinical, and angiographic factors associated with multivessel revascularization. RESULTS Among 664 STEMI patients with MVCAD, 251 (38%) underwent multivessel revascularization. Most revascularizations were staged during the index hospitalization (64.1%), and 8.0% were staged after discharge, with 27.9% performed during primary percutaneous coronary intervention. Multivessel revascularization was associated with age and more diseased vessels. At 1 year, multivessel revascularization was independently associated with improved symptoms (4.5 points higher SAQ angina frequency score; 95% confidence interval [CI]: 1.0 to 7.9) and QoL (6.6 points higher SAQ QoL score; 95% CI: 2.7 to 10.6). One-year mortality was not different between those who did and did not undergo multivessel revascularization (3.6% vs. 3.4%; log-rank test p = 0.88). CONCLUSIONS Multivessel revascularization improved angina and QoL in STEMI patients with MVCAD. Patient-centered outcomes should be considered in future trials of multivessel revascularization. (C) 2015 by the American College of Cardiology Foundation.

引用

页码：2104 / 2113

页数：10

共 38 条

[21] Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Stable Coronary Artery Disease A Systematic Review and Meta-Analysis of Randomized Clinical Trials [J].