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[NEJM最新论文]:心源性休克患者PCI策略对一年预后的影响
2018年12月06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 2018; 379:1699-1710

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、心源性休克及多血管病变冠心病患者,与立即处理多血管PCI相比,仅对犯罪血管的PCI患者复合终点(30天时全因死亡或需要肾脏替代治疗的严重肾功能衰竭)比例较低。我们对一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名患者随机分为仅处理犯罪病变PCI或立即处理多血管病变PCI组。我们既往报告了30天死亡或肾脏替代治疗等主要终点的结果。预先确定的次要终点(1年时)包括全因死亡,心梗复发,重复血管再通,因充血性心力衰竭再次住院,包括死亡或心梗复发的复合指标,以及包括死亡、心梗复发或因心衰再次入院。

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).

与既往报告相似,30天时,仅处理犯罪病变PCI组中45.9%发生主要预后终点,而多血管PCI组患者为55.4% (P=0.01)。一年时,仅处理犯罪血管组344名患者中的172名(50.0%)以及多血管PCI组341名患者中的194名 (56.9%) 患者死亡(相对危险度, 0.88; 95% 可信区间 [CI], 0.76 to 1.01)。仅处理犯罪血管PCI组1.7%心梗复发,多血管PCI组为2.1% (相对危险度0.85; 95% CI, 0.29 to 2.50),包括死亡和心梗复发的复合终点比例分别为50.9% 和 58.4%(相对危险度,0.87;95% CI, 0.76 to 1.00)。与多血管病变相关,仅处理犯罪血管PCI组更多患者需要重复血管再通(32.3% vs. 9.4%; 相对危险度, 3.44; 95% CI, 2.39 to 4.95),且更多患者因心衰再次住院(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.

对于急性心梗合并心源性休克患者,与立即行多血管PCI相比,仅处理犯罪血管PCI患者的30天死亡或肾脏替代的风险较低,随访1年时两组患者病死率无显著差异。

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

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