Complete Versus Culprit-Only Lesion Intervention in Patients With Acute Coronary Syndromes

被引：132

作者：

Rathod, Krishnaraj S. ^{[1
]}

Koganti, Sudheer ^{[1
]}

Jain, Ajay K. ^{[1
]}

Astroulakis, Zoe ^{[2
]}

Lim, Pitt ^{[2
]}

Rakhit, Roby ^{[3
]}

Kalra, Sundeep Singh ^{[3
]}

Dalby, Miles C. ^{[4
]}

O'Mahony, Constantinos ^{[1
]}

Malik, Iqbal S. ^{[5
]}

Knight, Charles J. ^{[1
]}

Mathur, Anthony ^{[1
]}

Redwood, Simon ^{[6
]}

Sirker, Alexander ^{[1
]}

MacCarthy, Philip A. ^{[7
]}

Smith, Elliot J. ^{[1
]}

Wragg, Andrew ^{[1
]}

Jones, Daniel A. ^{[1
]}

机构：

[1] Barts Hlth NHS Trust, London, England

[2] St Georges Healthcare NHS Fdn Trust, St Georges Hosp, London, England

[3] Royal Free London NHS Fdn Trust, London, England

[4] Royal Brompton & Harefield NHS Fdn Trust, Harefield Hosp, London, England

[5] Imperial Coll Healthcare NHS Fdn Trust, Hammersmith Hosp, London, England

[6] St Thomas NHS Fdn Trust, Guys & St Thomas Hosp, London, England

[7] Kings Coll Hosp NHS Fdn Trust, Kings Coll Hosp, Denmark Hill, London, England

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2018年 / 72卷 / 17期

关键词：

PCI; NSTEMI; multivessel intervention; myocardial infarction; ELEVATION MYOCARDIAL-INFARCTION; MULTIVESSEL DISEASE; ARTERY-DISEASE; COMPLETE REVASCULARIZATION; PERCUTANEOUS INTERVENTION; RANDOMIZED-TRIAL; UNSTABLE ANGINA; STEMI PATIENTS; VESSEL; METAANALYSIS;

D O I：

10.1016/j.jacc.2018.07.089

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND A large proportion of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) present with multivessel disease (MVD). There is uncertainty in the role of complete coronary revascularization in this group of patients. OBJECTIVES The aim of this study was to investigate the outcomes of complete revascularization compared with culprit vessel-only intervention in a large contemporary cohort of patients undergoing percutaneous coronary intervention (PCI) for NSTEMI. METHODS The authors undertook an observational cohort study of 37,491 NSTEMI patients treated between 2005 and 2015 at the 8 heart attack centers in London. Clinical details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society (BCIS) PCI dataset. A total of 21,857 patients (58.3%) presented with NSTEMI and MVD. Primary outcome was all-cause mortality at a median follow-up of 4.1 years (interquartile range: 2.2 to 5.8 years). RESULTS A total of 11,737 (53.7%) patients underwent single-stage complete revascularization during PCI for NSTEMI, rates that significantly increased during the study period (p = 0.006). Those patients undergoing complete revascularization were older and more likely to be male, diabetic, have renal disease and a history of previous myocardial infarction/revascularization compared with the culprit-only revascularization group. Although crude, in-hospital major adverse cardiac event rates were similar (5.2% vs. 4.8%; p = 0.462) between the 2 groups. Kaplan-Meier analysis demonstrated significant differences in mortality rates between the 2 groups (22.5% complete revascularization vs. 25.9% culprit vessel intervention; p = 0.0005) during the follow-up period. After multivariate Cox analysis (hazard ratio: 0.90; 95% confidence interval: 0.85 to 0.97) and the use of propensity matching (hazard ratio: 0.89; 95% confidence interval: 0.76 to 0.98) complete revascularization was associated with reduced mortality. CONCLUSIONS In NSTEMI patients with MVD, despite higher initial (in-hospital) mortality rates, single-stage complete coronary revascularization appears to be superior to culprit-only vessel PCI in terms of long-term mortality rates. This supports the need for further randomized study to confirm these findings. (c) 2018 by the American College of Cardiology Foundation.

引用

页码：1989 / 1999

页数：11

共 48 条

[1]

Amsterdam EA, 2014, J AM COLL CARDIOL, V64, pE139, DOI [10.1016/j.jacc.2014.09.017, 10.1161/CIR.0000000000000134, 10.1016/j.jacc.2014.10.011, 10.1016/j.jacc.2014.09.016]

[2]

[Anonymous], 2006, J Am Coll Cardiol, V47, pC1

[3] Complete vs Culprit-Only Percutaneous Coronary Intervention in STEMI With Multivessel Disease: A Meta-analysis and Trial Sequential Analysis of Randomized Trials [J].