在左主血管再循环化后自发性心肌梗塞:EXCEL试验
Mahesh V Madhavan1,2, John Gregson3, Bjorn Redfors2,4,5
1New York-Presbyterian Hospital and the Columbia University Irving Medical Center, New York, NY (M.V.M.).
Circulation
|February 10, 2026
概括
自发性心肌梗塞 (MI) 在穿皮冠状动脉干预 (PCI) 后比冠状动脉旁路移植 (CABG) 手术在左主冠状动脉疾病后更常发生. 这种MI独立地预测了两种程序后更高的死亡风险.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 关于自发性心肌梗塞 (MI) 发生率和左主冠状动脉疾病 (LMCAD) 重血管化后的结果的数据有限.
- 通过皮肤冠状动脉干预 (PCI) 后自发性心脏病与冠状动脉旁路移植 (CABG) 的比较对于了解长期预后至关重要.
研究的目的:
- 为了比较PCI后自发性MI的发病率与LMCAD的CABG.
- 评估自发性心脏病发作对心血管和所有原因死亡率在重血管化后5年的预后影响.
主要方法:
- 对LMCAD患者的EXCEL试验 (N=1882) 中自发性和手术性MI的分析.
- 考克斯比例危险回归用于评估心脏病发作和5年死亡结果之间的关联.
主要成果:
- 自发性心脏病发作发生在PCI后的6.8%,CABG后的3.4% (adjHR,2.01;P=0.002).
- 自发性心脏病在5年内独立预测心血管 (adjHR,9.39) 和全因死亡率 (adjHR,4.77) 的增加.
- 程序性MI也与死亡率的增加有关,但不如自发性MI那么强烈.
结论:
- 自发性心脏病发作在PCI后比CABG在LMCAD再血管化后更为频繁.
- 自发性心脏病显著增加了长期死亡风险,无论重血管化策略如何.
- 自发性心脏病发作带来了比大型程序性心脏病发作的死亡风险更高.
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