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

Autor:	Rathod KS; Barts Health NHS Trust, London, United Kingdom., Koganti S; Barts Health NHS Trust, London, United Kingdom., Jain AK; Barts Health NHS Trust, London, United Kingdom., Astroulakis Z; St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom., Lim P; St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom., Rakhit R; Royal Free London NHS Foundation Trust, London, United Kingdom., Kalra SS; Royal Free London NHS Foundation Trust, London, United Kingdom., Dalby MC; Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, London, United Kingdom., O'Mahony C; Barts Health NHS Trust, London, United Kingdom., Malik IS; Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom., Knight CJ; Barts Health NHS Trust, London, United Kingdom., Mathur A; Barts Health NHS Trust, London, United Kingdom., Redwood S; St. Thomas' NHS Foundation Trust, Guys & St. Thomas Hospital, London, United Kingdom., Sirker A; Barts Health NHS Trust, London, United Kingdom., MacCarthy PA; Kings College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom., Smith EJ; Barts Health NHS Trust, London, United Kingdom., Wragg A; Barts Health NHS Trust, London, United Kingdom., Jones DA; Barts Health NHS Trust, London, United Kingdom. Electronic address: daniel.jones@qmul.ac.uk.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2018 Oct 23; Vol. 72 (17), pp. 1989-1999.
DOI:	10.1016/j.jacc.2018.07.089
Abstrakt:	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. (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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