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在左侧主疾病中PCI后不完全重血管化的影响:EXCEL试验
Ziad A Ali1,2, Javier Jas Garcia1, Keyvan Karimi Galougahi2
1Cardiovascular Research Foundation, New York, NY (Z.A.A., J.J.G., J.H., A.G., O.B.-Y., B.R.).
Circulation. Cardiovascular interventions
|March 19, 2024
概括
对于左侧主要疾病的PCI后不完整的再血管化,特别是未经治疗的左侧环病变,会增加死亡和心脏病发作风险. 通过剩余的Jeopardy评分评估的完整的再血管化对于更好的结果至关重要.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 临床试验 临床试验
背景情况:
- 对于左主冠状动脉疾病 (CAD) 的穿皮冠状动脉干预 (PCI) 后的完整重血管化仍然是有争议的.
- 在EXCEL试验中,评估了PCI与冠状动脉旁路手术对左主回血管化的有效性.
研究的目的:
- 在接受PCI的左主CAD患者中研究完整重血管化的临床影响.
- 根据重血管化的不同定义来评估结果,包括解剖学,功能,残留SYNTAX评分和残留危险评分 (rJS).
主要方法:
- 分析了EXCEL试验中的903名患者.
- 在5年的随访中评估死亡率或心肌梗塞 (MI) 的复合率.
- 评估使用核心实验室对完全重血管化的定义,残留SYNTAX得分和rJS.
主要成果:
- 由rJS定义的不完整的重血管化 (≥4对≤2) 与明显更高的死亡率或心脏病发作率 (38.9%对19.5%;P=0.006) 相关.
- 在rJS≥4组中,死亡率增加和自发性心脏病发作导致风险更高.
- 左环动脉 (LCX) 的未经治疗的高度病变,特别是骨/近道病变,与更糟糕的结局有关 (18.9%与35.2%相比;HR,0.48;P<0.001).
结论:
- 不完整的再血管,特别是根据rJS标准,与左主PCI患者的不良结果有关.
- 在LCX中未经治疗的病变显著增加了死亡率和心脏病发作.
- 优化重血管化,专注于LCX,对于改善PCI后患者预后至关重要.
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