■我们试图评估不同血运重建策略在ST段抬高型心肌梗死(STEMI)和多支血管冠状动脉疾病并发心源性休克或慢性完全闭塞(CTO)患者中的相对优势。
最近的随机试验和荟萃分析显示,在患有STEMI和多支冠状动脉疾病的患者中,多支血管经皮冠状动脉介入治疗(PCI)与更好的预后相关。然而,合并心源性休克或CTO的患者被排除.
■研究比较了STEMI和多支冠状动脉疾病并发心源性休克或CTO患者的多支血管PCI(立即或分期)与仅罪魁祸首PCI。随机奇数比(OR)和95%置信区间(CI)。
■16项研究纳入8695例并发心源性休克患者,8项研究纳入2259例并发CTO患者。在并发心源性休克的患者中,联合PCI策略与短期肾衰竭风险较低相关(OR:0.75;95%CI:0.61-0.93;I2=0.0%),MACE没有显著差异,全因死亡率,再梗死,血运重建,心脏死亡,心力衰竭,大出血,或中风与立即MV-PCI策略相比。在CTO复杂的患者中,联合PCI策略与长期MACE的高风险相关(OR:2.06;95%CI:1.39-3.06;I2=54.0%),全因死亡率(OR:2.89;95%CI:2.09-4.00;I2=0.0%),心源性死亡(OR:3.12;95%CI:2.05-4.75;I2=16.8%),心力衰竭(OR:1.99;95%CI:1.22-3.24;I2=0.0%),和卒中(OR:2.80;95%CI:1.04-7.53;I2=0.0%)与分期MV-PCI策略相比,再梗死没有任何区别,血运重建,或者大出血.
■对于STEMI和多支冠状动脉疾病并发心源性休克的患者,由于短期肾功能衰竭的风险较高,因此不提倡立即进行多支血管PCI,而对于CTO复杂的患者,由于降低了长期MACE的风险,提倡分阶段的多血管PCI,全因死亡率,心脏死亡,心力衰竭,和中风。
UNASSIGNED: We sought to assess the relative merits of different revascularization strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease complicated by cardiogenic shock or chronic total occlusion (CTO).
UNASSIGNED: Recent randomized trials and meta-analysis have suggested that multivessel percutaneous coronary intervention (PCI) is associated with better outcomes in patients with STEMI and multivessel coronary artery disease, however, patients complicated by cardiogenic shock or CTO were excluded.
UNASSIGNED: Studies that compared multivessel PCI (immediate or staged) with culprit-only PCI in patients with STEMI and multivessel coronary artery disease complicated by cardiogenic shock or CTO were included. Random odd ratio (OR) and 95% confidence interval (CI) were conducted.
UNASSIGNED: Sixteen studies with 8695 patients complicated by cardiogenic shock and eight studies with 2259 patients complicated by CTO were included. In patients complicated by cardiogenic shock, a strategy of CO-PCI was associated with lower risk for short-term renal failure (OR: 0.75; 95% CI: 0.61-0.93; I2 = 0.0%), with no significant difference in MACE, all-cause mortality, re-infarction, revascularization, cardiac death, heart failure, major bleeding, or stroke compared with an immediate MV-PCI strategy. In patients complicated by CTO, a strategy of CO-PCI was associated with higher risk for long-term MACE (OR: 2.06; 95% CI: 1.39-3.06; I2 = 54.0%), all-cause mortality (OR: 2.89; 95% CI: 2.09-4.00; I2 = 0.0%), cardiac death (OR: 3.12; 95% CI: 2.05-4.75; I2 = 16.8%), heart failure (OR: 1.99; 95% CI: 1.22-3.24; I2 = 0.0%), and stroke (OR: 2.80; 95% CI: 1.04-7.53; I2 = 0.0%) compared with a staged MV-PCI strategy, without any difference in re-infarction, revascularization, or major bleeding.
UNASSIGNED: For patients with STEMI and multivessel coronary artery disease complicated by cardiogenic shock, an immediate multivessel PCI was not advocated due to a higher risk for short-term renal failure, whereas for patients complicated by CTO, a staged multivessel PCI was advocated due to reduced risks for long-term MACE, all-cause mortality, cardiac death, heart failure, and stroke.