急性心肌梗死和心源性休克患者的血管内图像引导经皮冠状动脉介入治疗

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia Pub Date : 2024-05-29 DOI:10.1016/j.recesp.2024.03.017

Hyun Sung Joh , Seung Hun Lee , Jinhwan Jo , Hyun Kuk Kim , Woo-Hyun Lim , Hack-Lyoung Kim , Jae-Bin Seo , Woo-Young Chung , Sang-Hyun Kim , Joo-Hee Zo , Myung-A. Kim , Min Chul Kim , Ju Han Kim , Young Joon Hong , Young Keun Ahn , Myung Ho Jeong , Seung Ho Hur , Doo Il Kim , Kiyuk Chang , Hun Sik Park , Joo Myung Lee

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引用次数: 0

摘要

导言和目的目前还没有关于血管内成像引导的经皮冠状动脉介入治疗（PCI）与血管造影引导的PCI相比对急性心肌梗死（AMI）和心源性休克患者疗效的临床数据。本研究旨在评估血管内成像引导的 PCI 对急性心肌梗死和心源性休克患者的影响。方法从 KAMIR-NIH（2011 年 11 月至 2015 年 12 月）和 KAMIR-V（2016 年 1 月至 2020 年 6 月）的全国汇总登记中的 28 732 例患者中，我们共选择了 1833 例（6.4%）急性心肌梗死和心源性休克患者，这些患者接受了罪魁祸首血管的 PCI。主要终点是 1 年后的主要不良心血管事件（MACE），即心源性死亡、心肌梗死、重复血管再通、明确或可能的支架血栓形成的综合结果。结果在研究人群中，375 名患者（20.5%）接受了血管内成像引导的 PCI，1458 名患者（79.5%）接受了血管造影引导的 PCI。血管内成像引导 PCI 的 1 年 MACE 风险明显低于血管造影引导 PCI（19.5% vs 28.2%；HR，0.59；95%CI，0.45-0.77；P < .001），主要原因是心脏死亡风险较低（13.7% vs 24.0%；调整后 HR，0.53；95%CI，0.39-0.72；P < .001）。这些结果在倾向评分匹配（HR，0.68；95%CI，0.46-0.99）、反概率加权（HR，0.61；95%CI，0.45-0.83）和贝叶斯分析（Odds ratio，0.66，95%可信区间，0.49-0.88）中都是一致的。结论在心源性休克的AMI患者中，血管内成像引导的PCI与血管造影引导的PCI相比，1年后发生MACE的风险较低，主要原因是心脏死亡的风险较低。

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Intervención coronaria percutánea guiada por imagen intravascular en pacientes con infarto agudo de miocardio y shock cardiogénico

Introduction and objectives

There are no clinical data on the efficacy of intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI in patients with acute myocardial infarction (AMI) and cardiogenic shock. The current study sought to evaluate the impact of intravascular imaging-guided PCI in patients with AMI and cardiogenic shock.

Methods

Among a total of 28 732 patients from the nationwide pooled registry of KAMIR-NIH (November, 2011 to December, 2015) and KAMIR-V (January, 2016 to June, 2020), we selected a total of 1833 patients (6.4%) with AMI and cardiogenic shock who underwent PCI of the culprit vessel. The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, a composite of cardiac death, myocardial infarction, repeat revascularization, and definite or probable stent thrombosis.

Results

Among the study population, 375 patients (20.5%) underwent intravascular imaging-guided PCI and 1458 patients (79.5%) underwent angiography-guided PCI. Intravascular imaging-guided PCI was associated with a significantly lower risk of 1-year MACE than angiography-guided PCI (19.5% vs 28.2%; HR, 0.59; 95%CI, 0.45-0.77; P < .001), mainly driven by a lower risk of cardiac death (13.7% vs 24.0%; adjusted HR, 0.53; 95%CI, 0.39-0.72; P < .001). These results were consistent in propensity score matching (HR, 0.68; 95%CI, 0.46-0.99), inverse probability weighting (HR, 0.61; 95%CI, 0.45-0.83), and Bayesian analysis (Odds ratio, 0.66, 95% credible interval, 0.49-0.88).

Conclusions

In AMI patients with cardiogenic shock, intravascular imaging-guided PCI was associated with a lower risk of MACE at 1-year than angiography-guided PCI, mainly driven by the lower risk of cardiac death.

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来源期刊

Revista espanola de cardiologia 医学-心血管系统

CiteScore

4.20

自引率

13.60%

发文量

257

审稿时长

28 days

期刊介绍： Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.