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[NEJM在线发表]:心源性休克患者PCI策略对一年预后的影响
2018年09月23日 时讯速递, 进展交流 暂无评论

ORIGINAL ARTICLE

One-Year Outcomes after PCI Strategies in Cardiogenic Shock

Holger Thiele, Ibrahim Akin, Marcus Sandri, et al

N Engl J Med August 25, 2018

DOI: 10.1056/NEJMoa1808788

Abstract

BACKGROUND 背景

Among patients with acute myocardial infarction, cardiogenic shock, and multivessel coronary artery disease, the risk of a composite of death from any cause or severe renal failure leading to renal-replacement therapy at 30 days was found to be lower with percutaneous coronary intervention (PCI) of the culprit lesion only than with immediate multivessel PCI. We evaluated clinical outcomes at 1 year.

对于急性心梗、心源性休克及冠脉多血管病变患者,与同时进行多血管PCI相比,仅处理犯罪血管时复合终点(30天全因死亡或需要肾脏替代治疗的严重肾功能衰竭)风险较低。我们对患者1年的临床预后进行评估。

METHODS 方法

We randomly assigned 706 patients to either culprit-lesion-only PCI or immediate multivessel PCI. The results for the primary end point of death or renal-replacement therapy at 30 days have been reported previously. Prespecified secondary end points at 1 year included death from any cause, recurrent myocardial infarction, repeat revascularization, rehospitalization for congestive heart failure, the composite of death or recurrent infarction, and the composite of death, recurrent infarction, or rehospitalization for heart failure.

我们将706名患者随机分组,即仅对犯罪血管进行PCI,或同时进行多血管PCI。以前曾报告主要终点(30天死亡或肾脏替代治疗)结果。预先确定的一年随访时次要预后终点包括全因死亡,心梗复发,再次血管重建,因充血性心力衰竭再次住院,包括死亡和心梗复发的复合终点,以及包括死亡、心梗复发或因心衰再次住院的复合终点。

RESULTS 结果

As reported previously, at 30 days, the primary end point had occurred in 45.9% of the patients in the culprit-lesion-only PCI group and in 55.4% in the multivessel PCI group (P=0.01). At 1 year, death had occurred in 172 of 344 patients (50.0%) in the culprit-lesion-only PCI group and in 194 of 341 patients (56.9%) in the multivessel PCI group (relative risk, 0.88; 95% confidence interval [CI], 0.76 to 1.01). The rate of recurrent infarction was 1.7% with culprit-lesion-only PCI and 2.1% with multivessel PCI (relative risk, 0.85; 95% CI, 0.29 to 2.50), and the rate of a composite of death or recurrent infarction was 50.9% and 58.4%, respectively (relative risk, 0.87; 95% CI, 0.76 to 1.00). Repeat revascularization occurred more frequently with culprit-lesion-only PCI than with multivessel PCI (in 32.3% of the patients vs. 9.4%; relative risk, 3.44; 95% CI, 2.39 to 4.95), as did rehospitalization for heart failure (5.2% vs. 1.2%; relative risk, 4.46; 95% CI, 1.53 to 13.04).

如既往报告,30天时,仅对犯罪血管进行PCI组患者45.9%以及多血管PCI组患者55.4%发生主要终点事件(P=0.01)。1年随访时,仅对犯罪血管进行PCI组344名患者中172名(50.0%)死亡,多血管PCI组341名患者中194名(56.9%)死亡(相对危险度0.88;95% 可信区间 [CI],0.76 to 1.01)。仅对犯罪血管进行PCI组及多血管PCI组患者心梗复发率分别为 1.7% 和 2.1%(相对危险度0.85;95% CI, 0.29 to 2.50),死亡与心梗复发的复合终点事件比例分别为 50.9% 和 58.4%(相对危险度0.87;95% CI, 0.76 to 1.00)。仅对犯罪血管进行PCI组患者再次血管重建病例较高(32.3% vs. 9.4%;相对危险度,3.44;95% CI,2.39 to 4.95),因心衰再次住院比例也较高(5.2% vs. 1.2%;相对危险度,4.46;95% CI,1.53 to 13.04)。

CONCLUSIONS 结论

Among patients with acute myocardial infarction and cardiogenic shock, the risk of death or renal-replacement therapy at 30 days was lower with culprit-lesion-only PCI than with immediate multivessel PCI, and mortality did not differ significantly between the two groups at 1 year of follow-up.

对于急性心梗和心源性休克患者,与多血管PCI相比,仅对犯罪血管进行PCI,30天死亡或肾脏替代治疗风险较低,随访1年时病死率无显著差异。

(Funded by the European Union Seventh Framework Program and others; CULPRIT-SHOCK ClinicalTrials.gov number, NCT01927549.)

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