仅在ST段抬高型心肌梗塞和多支血管疾病患者中进行完全血运重建和对立病变的治疗：DANAMI-3-PRIMULTI心脏磁共振研究。,JACC: Cardiovascular Interventions

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仅在ST段抬高型心肌梗塞和多支血管疾病患者中进行完全血运重建和对立病变的治疗：DANAMI-3-PRIMULTI心脏磁共振研究。
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2019-04-22 , DOI: 10.1016/j.jcin.2019.01.248
Kasper Kyhl ₁ , Kiril Aleksov Ahtarovski ₁ , Lars Nepper-Christensen ₁ , Kathrine Ekström ₁ , Adam Ali Ghotbi ₁ , Mikkel Schoos ₁ , Christoffer Göransson ₁ , Litten Bertelsen ₁ , Steffen Helqvist ₁ , Lene Holmvang ₁ , Erik Jørgensen ₁ , Frants Pedersen ₁ , Kari Saunamäki ₁ , Peter Clemmensen ₂ , Ole De Backer ₁ , Dan Eik Høfsten ₁ , Lars Køber ₁ , Henning Kelbæk ₃ , Niels Vejlstrup ₃ , Jacob Lønborg ₃ , Thomas Engstrøm ₄

Affiliation

目的本研究旨在评估分数流储备（FFR）引导的血运重建术与仅采用罪魁祸首的经皮冠状动脉介入治疗（PCI）对ST段抬高型心肌梗死（STEMI）患者对梗死面积，左心室的影响（LV），功能，LV重塑以及非罪犯梗塞的存在。背景技术仅与梗死相关动脉的PCI相比，完全血管重建后STEMI合并多支血管病变的患者可能会改善临床结局，但对梗死面积，左室功能和重塑以及围手术期梗塞风险的影响尚不清楚。方法在DANAMI-3（丹麦急性心肌梗死的第三次试验）-PRIMULTI（ST抬高型心肌梗塞和多支血管疾病患者的主要PCI）的子研究中：一项仅治疗Culprit病变或完全血管重建术的随机试验，将患有多支血管疾病的STEMI患者随机分为仅接受FFR指导的完全血管重建术或仅对罪犯血管进行PCI。入院期间和3个月的随访中，患者接受了心脏磁共振成像。结果共纳入280例患者（136例与梗死相关的患者和144例完全由FFR指导的血运重建）。心肌抢救指数（中位数为0.71 [四分位数]，最终梗死面积（中位数12％[四分位数范围：5％至19％]与11％[四分位数范围：4％至18％]，p = 0.62）无差异。范围：0.54至0.89] vs. 0.66 [四分位间距：0.55至0.87]； p = 0.49），左室射血分数（平均58±9％vs. 59±9％； p = 0.39），和左室收缩末期容积重塑（平均7±22 ml对7±19 ml； p = 0.63）。在完全实施血管重建术的患者中，在非罪犯干预之后发生的新的非罪犯梗塞在数字上更为频繁（6 [4.5％]对1 [0.8％]； p = 0.12）。结论与仅行凶手的PCI相比，STEMI和多支血管疾病患者的完全FFR引导的血运重建术不会影响最终的梗死面积，左室功能或重塑。

"点击查看英文标题和摘要"

Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A DANAMI-3-PRIMULTI Cardiac Magnetic Resonance Substudy.

OBJECTIVES The aim of this study was to evaluate the effect of fractional flow reserve (FFR)-guided revascularization compared with culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) on infarct size, left ventricular (LV), function, LV remodeling, and the presence of nonculprit infarctions. BACKGROUND Patients with STEMI with multivessel disease might have improved clinical outcomes after complete revascularization compared with PCI of the infarct-related artery only, but the impact on infarct size, LV function, and remodeling as well as the risk for periprocedural infarction are unknown. METHODS In this substudy of the DANAMI-3 (Third Danish Trial in Acute Myocardial Infarction)-PRIMULTI (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization) randomized trial, patients with STEMI with multivessel disease were randomized to receive either complete FFR-guided revascularization or PCI of the culprit vessel only. The patients underwent cardiac magnetic resonance imaging during index admission and at 3-month follow-up. RESULTS A total of 280 patients (136 patients with infarct-related and 144 with complete FFR-guided revascularization) were included. There were no differences in final infarct size (median 12% [interquartile range: 5% to 19%] vs. 11% [interquartile range: 4% to 18%]; p = 0.62), myocardial salvage index (median 0.71 [interquartile range: 0.54 to 0.89] vs. 0.66 [interquartile range: 0.55 to 0.87]; p = 0.49), LV ejection fraction (mean 58 ± 9% vs. 59 ± 9%; p = 0.39), and LV end-systolic volume remodeling (mean 7 ± 22 ml vs. 7 ± 19 ml; p = 0.63). New nonculprit infarction occurring after the nonculprit intervention was numerically more frequent among patients treated with complete revascularization (6 [4.5%] vs. 1 [0.8%]; p = 0.12). CONCLUSIONS Complete FFR-guided revascularization in patients with STEMI and multivessel disease did not affect final infarct size, LV function, or remodeling compared with culprit-only PCI.

更新日期：2019-04-15

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