现在的位置: 首页时讯速递, 进展交流>正文
[NEJM在线发表]:急性心梗合并心源性休克患者PCI新策略
2017年11月07日 时讯速递, 进展交流 暂无评论

ORIGINAL ARTICLE

PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

Holger Thiele, Ibrahim Akin, Marcus Sandri, et al

N Engl J Med 2017

October 30, 2017DOI: 10.1056/NEJMoa1710261

BACKGROUND 背景

In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be performed immediately for stenoses in nonculprit arteries is controversial.

对于急性心梗合并心源性休克患者,通过PCI对罪犯血管进行早期再血管化能够改善预后。然而,大多数心源性休克患者都有多血管病变,是否应当对非罪犯血管的狭窄进行立即PCI尚存在争议。

METHODS 方法

In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies: either PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, or immediate multivessel PCI. The primary end point was a composite of death or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Safety end points included bleeding and stroke.

在这项多中心临床试验中,我们将706名多血管病变,急性心梗且合并心源性休克患者随机分为两个初始再血管化策略组:仅对罪犯血管进行PCI,对于非罪犯血管择期进行再血管化,或立即进行多血管PCI。主要预后终点为复合终点,即随机分组后30天内死亡以及导致需要肾脏替代治疗的严重肾功能衰竭。安全性终点包括出血及卒中。

RESULTS 结果

At 30 days, the composite primary end point of death or renal-replacement therapy had occurred in 158 of the 344 patients (45.9%) in the culprit-lesion-only PCI group and in 189 of the 341 patients (55.4%) in the multivessel PCI group (relative risk, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.01). The relative risk of death in the culprit-lesion-only PCI group as compared with the multivessel PCI group was 0.84 (95% CI, 0.72 to 0.98; P=0.03), and the relative risk of renal-replacement therapy was 0.71 (95% CI, 0.49 to 1.03; P=0.07). The time to hemodynamic stabilization, the risk of catecholamine therapy and the duration of such therapy, the levels of troponin T and creatine kinase, and the rates of bleeding and stroke did not differ significantly between the two groups.

在第30天时,罪犯病变PCI组344名患者中158名(45.9%),多血管PCI组341名患者中189名(55.4%)出现复合终点(死亡或肾脏替代治疗)(相对危险度, 0.83; 95% 可信区间 [CI], 0.71 to 0.96; P=0.01)。与多血管PCI组相比,罪犯病变PCI组死亡的相对危险度为 0.84 (95% CI, 0.72 to 0.98; P=0.03),肾脏替代治疗的相对危险度为 0.71 (95% CI, 0.49 to 1.03; P=0.07)。

CONCLUSIONS 结论

Among patients who had multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of a composite of death or severe renal failure leading to renal-replacement therapy was lower among those who initially underwent PCI of the culprit lesion only than among those who underwent immediate multivessel PCI. (Funded by the European Union 7th Framework Program and others; CULPRIT-SHOCK ClinicalTrials.gov number, NCT01927549.)

对于多血管冠心病、急性心梗合并心源性休克患者,与立即进行多血管PCI相比,初始治疗仅对罪犯血管进行PCI,患者30天出现死亡或导致肾脏替代治疗的严重肾功能衰竭的风险较低。

 

给我留言

您必须 [ 登录 ] 才能发表留言!

×
腾讯微博