急性ST段抬高型心肌梗死合并多支冠状动脉病变血运重建策略研究进展
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摘要
急性ST段抬高型心肌梗死(STEMI)合并多支冠状动脉病变比较常见,对患者死亡率及预后产生不良影响。与单支冠状动脉病变相比,多支冠状动脉病变患者临床预后差。随着医学发展以及指南更新,STEMI合并多支冠状动脉病变血运重建策略有了新的变化。对于血流动力学稳定的STEMI患者,急诊经皮冠状动脉介入(PCI)治疗时可同时或另行分期处理非梗死相关动脉;对于血流动力学不稳定的STEMI患者,完全血运重建可能增加手术并发症、心力衰竭恶化、对比剂肾病的风险,急性期仅处理梗死相关动脉(IRA)是合理的。本文就STEMI合并多支冠状动脉病变血运重建策略作一综述。
ST-segment elevation myocardial infarction(STEMI) is commonly complicated with multivessel coronary artery disease(MVD), and this condition often exerts adverse effects on mortality and prognosis. Compared with single coronary artery disease, MVD is usually associated with poor prognosis. With the development of medical science and update of guidelines, the revascularization strategy for STEMI with MVD has changed dramatically. Emergency percutaneous coronary intervention(PCI) can treat non-infarct-related arteries simultaneously or separately by different stages. However, for those STEMI patients with unstable hemodynamics, complete revascularization increases the risk of complications, deterioration of heart failure and contrast-induced nephropathy. It is reasonable to treat infarct related artery(IRA) only in acute stage. This article reviews the revascularization strategies for STEMI complicated with MVD.
ST-segment elevation myocardial infarction(STEMI) is commonly complicated with multivessel coronary artery disease(MVD), and this condition often exerts adverse effects on mortality and prognosis. Compared with single coronary artery disease, MVD is usually associated with poor prognosis. With the development of medical science and update of guidelines, the revascularization strategy for STEMI with MVD has changed dramatically. Emergency percutaneous coronary intervention(PCI) can treat non-infarct-related arteries simultaneously or separately by different stages. However, for those STEMI patients with unstable hemodynamics, complete revascularization increases the risk of complications, deterioration of heart failure and contrast-induced nephropathy. It is reasonable to treat infarct related artery(IRA) only in acute stage. This article reviews the revascularization strategies for STEMI complicated with MVD.
引文
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[3]巫刚,宋海峰,孙德醒.非梗死相关动脉择期经皮冠状动脉介入治疗不同处理时机对ST段抬高型心肌梗死患者预后的影响[J].中华老年多器官疾病杂志,2017,16(11):841-845.DOI:10.11915/j.issn.1671-5403.2017.11.195.Wu G,Song HF,Sun DX.Prognostic impact of different waiting times for elective PCI in non-infarct-related arteries in patients with ST-segment elevation myocardial infarction[J].Chin J Mult Organ Dis Elderly,2017,16(11):841-845.DOI:10.11915/j.issn.1671-5403.2017.11.195.
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[8]Lnborg J,Engstrm T,Kelbk H,et al.Fractional flow reserveguided complete revascularization improves the prognosis in patients with ST-segment-elevation myocardial infarction and severe nonculprit disease:a DANAMI 3-PRIMULTI substudy(primary PCI in patients with ST-elevation myocardial infarction and multivessel disease:treatment of culprit lesion only or complete revascularization)[J].Circ Cardiovasc Interv,2017,10(4).pii:e004460.DOI:10.1161/CIRCINTERVENTIONS.116.004460.
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[11]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.DOI:10.3760/cma.j.issn.0253-3758.2016.05.006.Group of Interventional Cardiology,Chinese Society of Cardiology,Thrombosis Prevention and Treatment Committee of Chinese College of Cardiovascular Physicians,Editorial Board of Chinese Journal of Cardiovascular Disease.Guidelines for percutaneous coronary intervention in China(2016)[J].Chin J Cardiol,2016,44(5):382-400.DOI:10.3760/cma.j.issn.0253-3758.2016.05.006.
[12]Aissaoui N,Puymirat E,Simon T,et al.Long-term outcome in early survivors of cardiogenic shock at the acute stage of myocardial infarction:a landmark analysis from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction(FAST-MI)registry[J].Crit Care,2014,18(5):516.DOI:10.1186/s13054-014-0516-y.
[13]Islam MS,Panduranga P,Al-Mukhaini M,et al.In-hospital outcome of patients with cardiogenic shock complicating acute myocardial infarction:results from Royal hospital percutaneous coronary intervention registry,Oman[J].Oman Med J,2016,31(1):46-51.DOI:10.5001/omj.2016.09.
[14]Wayangankar SA,Bangalore S,Mc Coy LA,et al.Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction:a report from the CathPCI registry[J].JACC Cardiovasc Interv,2016,9(4):341-351.DOI:10.1016/j.jcin.2015.10.039.
[15]Van Herck JL,Claeys MJ,De Paep R,et al.Management of cardiogenic shock complicating acute myocardial infarction[J].Eur Heart J Acute Cardiovasc Care,2015,4(3):278-297.DOI:10.1177/2048872614568294.
[16]Thiele H,Akin I,Sandri M,et al.PCI strategies in patients with acute myocardial infarction and cardiogenic shock[J].N Engl JMed,2017,377(25):2419-2432.DOI:10.1056/NEJ-Moa1710261.
[17]Thiele H,Akin I,Sandri M.One-year outcomes after PCIstrategies in cardiogenic shock[J].N Engl J Med,2018,379(18):1699-1710.DOI:10.1056/NEJMoa1808788.
[18]de Waha S,Jobs A,Eitel I,et al.Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction:a systematic review and meta-analysis[J].Eur Heart J Acute Cardiovasc Care,2018,7(1):28-37.DOI:10.1177/2048872617719640.
[19]Kolte D,Sardar P,Khera S,et al.Culprit vessel-only versus multivessel percutaneous coronary intervention in patients with cardiogenic shock complicating ST-segment-elevation myocardial infarction:a collaborative meta-analysis[J].Circ Cardiovasc Interv,2017,10(11).pii:e005582.DOI:10.1161/CIR-CINTERVENTIONS.117.005582.
[20]Neumann FJ,Sousa-Uva M,Ahlsson A,et al.2018 ESC/EACTSguidelines on myocardial revascularization[J].Kardiol Pol,2018,76(12):1585-1664.DOI:10.5603/KP.2018.0228.
[2]Windecker S,Kolh P,Alfonso F,et al.2014 ESC/EACTS guidelines on myocardial revascularization:the task force on myocardial revascularization of the European Society of Cardiology(ESC)and the European Association for Cardio-Thoracic Surgery(EACTS)developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions(EAPCI)[J].Eur Heart J,2014,35(37):2541-2619.DOI:10.1093/eurheartj/ehu278.
[3]巫刚,宋海峰,孙德醒.非梗死相关动脉择期经皮冠状动脉介入治疗不同处理时机对ST段抬高型心肌梗死患者预后的影响[J].中华老年多器官疾病杂志,2017,16(11):841-845.DOI:10.11915/j.issn.1671-5403.2017.11.195.Wu G,Song HF,Sun DX.Prognostic impact of different waiting times for elective PCI in non-infarct-related arteries in patients with ST-segment elevation myocardial infarction[J].Chin J Mult Organ Dis Elderly,2017,16(11):841-845.DOI:10.11915/j.issn.1671-5403.2017.11.195.
[4]Pundziute G,Schuijf JD,Jukema JW,et al.Evaluation of plaque characteristics in acute coronary syndromes:noninvasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis[J].Eur Heart J,2008,29(19):2373-2381.DOI:10.1093/eurheartj/ehn356.
[5]Dai J,Xing L,Jia H,et al.In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction:a clinical,angiographical,and intravascular optical coherence tomography study[J].European Heart J,2018,39(22):2077-2085.DOI:10.1093/eurheartj/ehy101.
[6]Wald DS,Morris JK,Wald NJ,et al.Randomized trial of preventive angioplasty in myocardial infarction[J].N Engl J Med,2013,369(12):1115-1123.DOI:10.1056/NEJMoa1305520.
[7]Gershlick AH,Khan JN,Kelly DJ,et al.Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease:the CvLPRIT trial[J].J Am Coll Cardiol,2015,65(10):963-972.DOI:10.1016/j.jacc.2014.12.038.
[8]Lnborg J,Engstrm T,Kelbk H,et al.Fractional flow reserveguided complete revascularization improves the prognosis in patients with ST-segment-elevation myocardial infarction and severe nonculprit disease:a DANAMI 3-PRIMULTI substudy(primary PCI in patients with ST-elevation myocardial infarction and multivessel disease:treatment of culprit lesion only or complete revascularization)[J].Circ Cardiovasc Interv,2017,10(4).pii:e004460.DOI:10.1161/CIRCINTERVENTIONS.116.004460.
[9]Smits PC,Boxma-de Klerk BM.Fractional flow reserve-guided multivessel angioplasty in myocardial infarction[J].N Engl J Med,2017,377(4):397-398.DOI:10.1056/NEJMc1706275.
[10]Levine GN,Bates ER,Blankenship JC,et al.2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction:an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHAguideline for the management of ST-elevation myocardial infarction[J].J Am Coll Cardiol,2016,67(10):1235-1250.DOI:10.1016/j.jacc.2015.10.005.
[11]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.DOI:10.3760/cma.j.issn.0253-3758.2016.05.006.Group of Interventional Cardiology,Chinese Society of Cardiology,Thrombosis Prevention and Treatment Committee of Chinese College of Cardiovascular Physicians,Editorial Board of Chinese Journal of Cardiovascular Disease.Guidelines for percutaneous coronary intervention in China(2016)[J].Chin J Cardiol,2016,44(5):382-400.DOI:10.3760/cma.j.issn.0253-3758.2016.05.006.
[12]Aissaoui N,Puymirat E,Simon T,et al.Long-term outcome in early survivors of cardiogenic shock at the acute stage of myocardial infarction:a landmark analysis from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction(FAST-MI)registry[J].Crit Care,2014,18(5):516.DOI:10.1186/s13054-014-0516-y.
[13]Islam MS,Panduranga P,Al-Mukhaini M,et al.In-hospital outcome of patients with cardiogenic shock complicating acute myocardial infarction:results from Royal hospital percutaneous coronary intervention registry,Oman[J].Oman Med J,2016,31(1):46-51.DOI:10.5001/omj.2016.09.
[14]Wayangankar SA,Bangalore S,Mc Coy LA,et al.Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction:a report from the CathPCI registry[J].JACC Cardiovasc Interv,2016,9(4):341-351.DOI:10.1016/j.jcin.2015.10.039.
[15]Van Herck JL,Claeys MJ,De Paep R,et al.Management of cardiogenic shock complicating acute myocardial infarction[J].Eur Heart J Acute Cardiovasc Care,2015,4(3):278-297.DOI:10.1177/2048872614568294.
[16]Thiele H,Akin I,Sandri M,et al.PCI strategies in patients with acute myocardial infarction and cardiogenic shock[J].N Engl JMed,2017,377(25):2419-2432.DOI:10.1056/NEJ-Moa1710261.
[17]Thiele H,Akin I,Sandri M.One-year outcomes after PCIstrategies in cardiogenic shock[J].N Engl J Med,2018,379(18):1699-1710.DOI:10.1056/NEJMoa1808788.
[18]de Waha S,Jobs A,Eitel I,et al.Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction:a systematic review and meta-analysis[J].Eur Heart J Acute Cardiovasc Care,2018,7(1):28-37.DOI:10.1177/2048872617719640.
[19]Kolte D,Sardar P,Khera S,et al.Culprit vessel-only versus multivessel percutaneous coronary intervention in patients with cardiogenic shock complicating ST-segment-elevation myocardial infarction:a collaborative meta-analysis[J].Circ Cardiovasc Interv,2017,10(11).pii:e005582.DOI:10.1161/CIR-CINTERVENTIONS.117.005582.
[20]Neumann FJ,Sousa-Uva M,Ahlsson A,et al.2018 ESC/EACTSguidelines on myocardial revascularization[J].Kardiol Pol,2018,76(12):1585-1664.DOI:10.5603/KP.2018.0228.