作者
Giorgio Quadri,Fabrizio D’Ascenzo,Claudio Moretti,Maurizio D’Amico,Sergio Raposeiras‐Roubín,Emad Abu‐Assi,José P.S. Henriques,Jorge Saucedo,José Ramón González-Juanatey,Stephen B. Wilton,Wouter J. Kikkert,Iván J. Núñez‐Gil,Albert Ariza‐Solé,Xiaoyan Song,Dimitrios Alexopoulos,Christoph Liebetrau,Tetsuma Kawaji,Zenon Huczek,Shaoping Nie,Toshiharu Fujii,Luís Cláudio Lemos Correia,Masa‐aki Kawashiri,José Marı́a Garcı́a-Acuña,Danielle Southern,Emilio Alfonso,Belén Terol,Alberto Garay,Dongfeng Zhang,Yalei Chen,Ioanna Xanthopoulou,Neriman Osman,Helge Möllmann,Hiroki Shiomi,Pierluigi Omedè,Antonio Montefusco,Francesca Giordana,Silvia Scarano,Michał Kowara,Krzysztof J. Filipiak,Xiao Wang,Yan Yan,Jingyao Fan,Yuji Ikari,Takuya Nakahashi,Kenji Sakata,Masakazu Yamagishi,Oliver Kalpak,Saško Kedev,Ferdinando Varbella,Fiorenzo Gaïta
摘要
The benefit of complete or incomplete percutaneous coronary intervention (PCI) in patients with myocardial infarction and multivessel disease remains debated. The aim of our study was to compare a complete vs. a "culprit only" revascularisation strategy in patients with myocardial infarction distinguishing the different clinical subsets (STEMI and NSTEMI) and to provide one-year clinical outcome from the "real-life" BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry.We conducted a multicentre study including all patients with myocardial infarction and multivessel coronary disease included in the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry. They were divided into two groups, complete revascularisation (CR) and incomplete revascularisation (IR). The primary endpoint was the death rate at one-year follow-up. Secondary endpoints were in-hospital repeat myocardial infarction (re-AMI), in-hospital heart failure (HF), major adverse cardiovascular events (MACE) and myocardial infarction at one year. Four thousand five hundred and twenty patients were included in our analysis, with a diagnosis of STEMI in 67.7% and NSTEMI in 32.3%. CR was performed in 27.2% and 42.4%, respectively. At univariate analysis, in-hospital and one-year outcomes were similar between CR and IR in STEMI patients (all p-values >0.05). In NSTEMI patients, CR was associated with a lower one-year death rate (4.5% vs. 8.5%; p=0.002), re-AMI (3.7% vs. 6.6%; p=0.016) and MACE (8.1% vs. 13.9%; p=0.001). After propensity score matching, CR also reduced events in STEMI patients, including one-year mortality (5.3% vs. 13.8%; p<0.001), re-AMI (4.9% vs. 17.4%; p<0.001) and MACE (8.5% vs. 24.6%; p<0.001).This multicentre retrospective registry showed the benefit of CR in terms of reduction of one-year mortality in patients with myocardial reinfarction and multivessel coronary disease. Randomised controlled trials including functional evaluation of the lesions should be performed to confirm our results.