st段抬高型心肌梗死合并多血管病变的血运重建策略

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-05-26 DOI:10.1016/j.jcin.2025.02.017

Felix Lindberg MD, PhD , Brynjölfur Mogensen MD , Sergio Buccheri MD, PhD , Fadi Jokhaji MD , Nils Witt MD, PhD , Colin Berry MD, PhD , Tomas Jernberg MD, PhD , Giovanna Sarno MD, PhD , Dimitrios Venetsanos MD, PhD , Stefan James MD, PhD , Felix Böhm MD, PhD

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引用次数: 0

摘要

背景：随机试验支持血管造影和生理引导下的st段抬高型心肌梗死（STEMI）合并多血管疾病（MVD）的完全血运重建术（CR） vs不完全血运重建术（IR）。这些策略在临床实践中的实施是不确定的。目的：在接受经皮冠状动脉介入治疗STEMI合并MVD的患者中，我们评估了不同血运重建策略和相关结果的时间趋势。方法：我们纳入了来自SWEDEHEART（瑞典根据推荐疗法评估心脏病的循证护理增强和发展网络系统）登记处的20,131例患者，这些患者在2009年至2021年间接受了STEMI合并MVD的初级经皮冠状动脉介入治疗。主要终点是全因死亡率、心肌梗死或计划外血运重建术的综合结果，在指数后90天标记，以说明这段时间内的分期手术。结果我们观察到CR的使用率有所增加(2009年：33% [n = 397 / 1,217]；2015年：46% [n = 767 / 1658]；2021年：51% [n = 816 / 1603]；P-trend & lt;0.001)和生理引导CR(2009年：0%[1,217例中n = 0]；2015年：7% [n = 119 / 1658]；2021年：14% [n = 218 / 1603]；P-trend & lt;0.001)。在4.2年的中位随访中（Q1-Q3: 1.8-7.1年），血管造影CR与IR（调整HR [aHR]: 0.84, 95% CI: 0.79-0.89）和生理引导CR与IR （aHR: 0.80, 95% CI: 0.69-0.93）发生原发性事件的调整风险较低，但生理引导CR与血管造影CR （aHR: 0.94, 95% CI: 0.80-1.11）的调整风险较低。结论在STEMI和MVD患者中，CR和生理引导手术的实施随着时间的推移而增加。截至2021年，51%的患者接受了CR， 14%的患者接受了生理引导下的CR。无论是血管造影还是生理引导下的CR，都与包括死亡率在内的有利结果独立相关。

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Revascularization Strategies in ST-Segment Elevation Myocardial Infarction With Multivessel Disease

Background

Randomized trials support angiographic and physiology-guided complete revascularization (CR) vs incomplete revascularization (IR) in ST-segment elevation myocardial infarction (STEMI) with multivessel disease (MVD). The implementation of these strategies in clinical practice is uncertain.

Objectives

In patients undergoing percutaneous coronary intervention for STEMI with MVD, we assessed temporal trends in the utilization of different revascularization strategies and associated outcomes.

Methods

We included 20,131 patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry who underwent primary percutaneous coronary intervention for STEMI with MVD between 2009 and 2021. Primary outcome was a composite of all-cause mortality, myocardial infarction, or unplanned revascularization, landmarked at 90 days postindex to account for staged procedures during this time.

Results

We observed increased adoption of CR (2009: 33% [n = 397 of 1,217]; 2015: 46% [n = 767 of 1,658]; 2021: 51% [n = 816 of 1,603]; P-trend < 0.001) and physiology-guided CR (2009: 0% [n = 0 of 1,217]; 2015: 7% [n = 119 of 1,658]; 2021: 14% [n = 218 of 1,603]; P-trend < 0.001). Over a median follow-up of 4.2 years (Q1-Q3: 1.8-7.1 years), the adjusted risk of a primary event was lower with angiographic CR vs IR (adjusted HR [aHR]: 0.84, 95% CI: 0.79-0.89) and physiology-guided CR vs IR (aHR: 0.80, 95% CI: 0.69-0.93) but not physiology-guided CR vs angiographic CR (aHR: 0.94, 95% CI: 0.80-1.11).

Conclusions

In patients with STEMI and MVD, the implementation of CR and physiology-guided procedures increased over time. As of 2021, 51% of patients underwent CR and 14% physiology-guided CR. CR, whether angiographically or physiology guided, was independently associated with favorable outcomes, including mortality.

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.