STEMI多支病变

1、Approximately 50% of patients with STEMI have multivessel diseaseCULPRIT ARTERYONLY VERSUSMULTIVESSEL PCIDate of download: 5/21/2016Copyright 2016 American Medical Association. All rights reserved.From: Extent, Location, and Clinical Significance of NonInfarct-Related Coronary Artery Disease Among P

2、atients With ST-Elevation Myocardial InfarctionJAMA. 2014;312(19):2019-2027. doi:10.1001/jama.2014.15095Date of download: 5/21/2016Copyright 2016 American Medical Association. All rights reserved.From: Extent, Location, and Clinical Significance of NonInfarct-Related Coronary Artery Disease Among Pa

3、tients With ST-Elevation Myocardial InfarctionJAMA. 2014;312(19):2019-2027. doi:10.1001/jama.2014.15095Kaplan-Meier Curve for 30-Day Mortality Between Patients With and Without Obstructive NonInfarct-Related Artery (Non-IRA) DiseaseAmong 28282 patients, 15 patients with missing information on mortal

4、ity (6 patients were missing any indication of death and 9 did not have data on time to death) were excluded (n=28267).Figure Legend: PCI options for patients withSTEMI and multivessel disease1) culprit arteryonly primary PCI, with PCI of nonculprit arteries only for spontaneous ischemia or intermed

5、iate- or high-risk findingson predischarge noninvasive testing; 2) multivessel PCI at the time of primary PCI; 3) culprit arteryonly primary PCI followed by staged PCI of nonculprit arteriesObservational studies, randomized controlled trials (RCTs), and meta-analyses comparing culprit arteryonly PCI

6、 with multivessel PCI have reported conflicting results CULPRIT ARTERYONLYHannan EL, et al. Culprit vessel percutaneous coronary intervention versus multivessel and staged percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel disease. J Am Coll C

7、ardiol Intv. 2010;3:2231.Toma M, et al. Nonculprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial. Eur Heart J. 2010;31:17017. 13. Vlaar PJ, Mahmoud KD, Holmes、Dziewierz A, et al. Impact of multivessel coro

8、nary artery disease and noninfarctrelated artery revascularization on outcome of patients with ST-elevation myocardial infarctiontransferred for primary percutaneous coronary intervention (from the EUROTRANSFER Registry). Am J Cardiol. 2010;106:3427. multivessel PCIEngstrm T, et al. Complete revascu

9、larisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI 3-PRIMULTI): an open-label, randomised controlled trial. Lancet. 2015;386:66571.Gershlick AH, et al. Randomized trial of complete versus lesion-only reva

10、scularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel Disease: the CvLPRIT trial. J Am Coll Cardiol. 2015;65:96372.Wald DS, et, PRAMI Investigators. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med. 2013;369:1115112

11、3. Complete revascularisation versus treatment of the culpritlesion only in patients with ST-segment elevation myocardialinfarction and multivessel disease (DANAMI-3PRIMULTI):an open-label, randomised controlled trialInclusion Criteria After successful treatment of the culprit lesion in the infarct-

12、related artery (defi ned as a thrombolysis in myocardial infarction , members of the invasive PCI team asked patients with an angiographic diameter stenosis of greater than 50% in one or more non-infarct-related arteries to participate in our trial. exclusion criteria intolerance of contrast media o

13、r of relevant anticoagulant or antithrombotic drugs, unconsciousness or cardiogenic shock, stent thrombosis, indication for coronary-artery bypass grafting, or increased bleeding risk.multivessel disease Procedureseverolimus-eluting stents2 days after the initial PCI procedure before discharge, according to local routinesFFR values of080 or lower signifi cant and treated those lesions, in addition to visually estimated stenoses greater than 90%.The