在心肌梗塞中立即或延迟的非罪祸首损伤PCI
Robin Nijveldt1, Michael Maeng2,3, Casper W H Beijnink1
1Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
The New England journal of medicine
|October 29, 2025
概括
对于STEMI患者的非罪祸首病变,即时的IFR引导PCI并不优于延迟的MRI引导PCI. 这两种策略都显示了死亡,心脏病发作或心力衰竭住院治疗的3年结果相似.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 在ST段升高心肌梗塞 (STEMI) 患者中治疗非罪祸首病变的最佳时间尚不清楚.
- 本研究将即时穿皮冠状动脉干预 (PCI) 以即时无波比 (iFR) 为指导,与延迟PCI以心脏应激磁共振成像 (MRI) 为指导的STEMI多血管疾病患者进行比较.
研究的目的:
- 为了比较立即iFR引导的PCI与延迟的MRI引导的PCI在STEMI患者的非罪祸首病变的疗效.
- 为了评估死亡,3年复合终点,复发性心肌梗塞或心力衰竭住院治疗.
主要方法:
- 一项国际,随机,受控试验,涉及1146名多血管疾病的STEMI患者.
- 患者被分配到即时的iFR引导PCI (iFR ≤0.89) 或延迟的MRI引导PCI在6周内.
- 主要终点在3年随访后进行评估.
主要成果:
- 在iFR组中的42.6%的患者接受了非致病病变的PCI,而在MRI组中为18.7%.
- 主要终点发生在9.3%的iFR组和9.8%的MRI组 (HR,0.95;95% CI,0.65-1.40;P=0.81).
- 两组之间严重不良事件没有显著差异.
结论:
- 立即iFR引导的非罪祸首病变PCI在STEMI患者中不优于延迟的MRI引导的PCI.
- 两种策略都显示了与主要心血管不良事件有关的可比的3年结果.
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