Jeehoon Kang, Sungjoon Park, Minju Han, Kyung Woo Park, Jung-Kyu Han, Han-Mo Yang, Hyun-Jae Kang, Bon-Kwon Koo, Hyo-Soo Kim
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引用次数: 0
Abstract
Background and objectives: The clinical benefits of complete revascularization (CR) in acute myocardial infarction (AMI) patients are unclear. Moreover, the benefit of CR is unknown in AMI with diabetes mellitus (DM) patients. We sought to compare the prognosis of CR and incomplete revascularization (IR) in patients with AMI and multivessel disease, according to the presence of DM.
Methods: A total of 2,150 AMI patients with multivessel coronary artery disease were analyzed. CR was defined based on the angiographic image. The primary endpoint of this study was the patient-oriented composite outcome (POCO) defined as a composite of all-cause death, any myocardial infarction, and any revascularization within 3 years.
Results: Overall, 3-year POCO was significantly lower in patients receiving angiographic CR (985 patients, 45.8%) compared with IR (1,165 patients, 54.2%). When divided into subgroups according to the presence of DM, CR reduced 3-year clinical outcomes in the non-DM group but not in the DM group (POCO: 11.7% vs. 23.2%, p<0.001, any revascularization: 7.2% vs. 10.8%, p=0.024 in the non-DM group, POCO: 24.3% vs. 27.8%, p=0.295, any revascularization: 13.3% vs. 11.3%, p=0.448 in the DM group, for CR vs. IR). Multivariate analysis showed that CR significantly reduced 3-year POCO (hazard ratio, 0.52; 95% confidence interval, 0.36-0.75) only in the non-DM group.
Conclusions: In AMI patients with multivessel disease, CR may have less clinical benefit in DM patients than in non-DM patients.
背景和目的：急性心肌梗死（AMI）患者完全血管再通（CR）的临床获益尚不明确。此外，CR 对合并糖尿病（DM）的 AMI 患者的益处尚不清楚。我们试图根据糖尿病的存在情况，比较AMI和多血管疾病患者CR和不完全血管再通（IR）的预后：方法：我们分析了2150名患有多支冠状动脉疾病的AMI患者。CR根据血管造影图像进行定义。本研究的主要终点是以患者为导向的综合结果（POCO），即3年内全因死亡、任何心肌梗死和任何血管再通的综合结果：总体而言，血管造影 CR 患者（985 例，45.8%）的 3 年 POCO 明显低于 IR 患者（1,165 例，54.2%）。如果根据是否存在糖尿病分为不同的亚组，CR可降低非糖尿病组患者的3年临床预后，但不会降低糖尿病组患者的3年临床预后（POCO：11.7% vs. 23.2%，P结论：在患有多血管疾病的AMI患者中，CR对DM患者的临床益处可能小于非DM患者。
期刊介绍：
Korean Circulation Journal is the official journal of the Korean Society of Cardiology, the Korean Pediatric Heart Society, the Korean Society of Interventional Cardiology, and the Korean Society of Heart Failure. Abbreviated title is ''Korean Circ J''.
Korean Circulation Journal, established in 1971, is a professional, peer-reviewed journal covering all aspects of cardiovascular medicine, including original articles of basic research and clinical findings, review articles, editorials, images in cardiovascular medicine, and letters to the editor. Korean Circulation Journal is published monthly in English and publishes scientific and state-of-the-art clinical articles aimed at improving human health in general and contributing to the treatment and prevention of cardiovascular diseases in particular.
The journal is published on the official website (https://e-kcj.org). It is indexed in PubMed, PubMed Central, Science Citation Index Expanded (SCIE, Web of Science), Scopus, EMBASE, Chemical Abstracts Service (CAS), Google Scholar, KoreaMed, KoreaMed Synapse and KoMCI, and easily available to wide international researchers
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