Background

Historical cohorts have shown extent of coronary artery disease to be a predictor of poorer outcomes in ST-segment elevation myocardial infarction. However, contemporary data in the era of reperfusion and modern secondary prevention therapy are lacking.

Aim

To compare 3-year survival in patients with ST-segment elevation myocardial infarction with multivessel disease versus those with single-vessel disease.

Methods

Using data from the FAST-MI 2005, 2010 and 2015 registries, three nationwide French surveys, we included all patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 24 hours of symptom onset. Baseline characteristics, management and 3-year all-cause mortality were analysed according to coronary status (single-, two- and three-vessel disease).

Results

Among 3907 patients (mean age 62.4 ± 13.7 years; 75.9% male), patients with multivessel disease (two- or three-vessel disease) accounted for 47.9%; overall, they were older, with higher cardiovascular risk profiles. In a multivariable adjusted Cox proportional hazard regression model, only patients with three-vessel disease had a higher rate of mortality at 3 years compared with those with single-vessel disease (hazard ratio 1.52, 95% confidence interval 1.68–2.26; P < 0.001). Finally, patients with multivessel disease with complete myocardial revascularization before discharge had a similar prognosis to patients with single-vessel disease (hazard ratio 1.17, 95% confidence interval 0.84–1.64; P = 0.35).

Conclusions

Multivessel disease still represents an important proportion of patients with ST-segment elevation myocardial infarction. Although three-vessel disease is associated with higher 3-year mortality, patients with multivessel disease and complete myocardial revascularization in the contemporary era have a 3-year risk of death similar to that in patients with single-vessel disease.

中文翻译：

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在再灌注和现代二级预防治疗时代，根据冠状动脉疾病程度的 ST 段抬高心肌梗死后的长期死亡率：FAST-MI 登记

背景

历史队列显示，冠状动脉疾病的程度是 ST 段抬高型心肌梗死预后较差的预测因素。然而，缺乏再灌注时代和现代二级预防治疗的当代数据。

目的

比较 ST 段抬高型心肌梗死合并多支血管病变患者与单支血管病变患者的 3 年生存率。

方法

使用来自 FAST-MI 2005、2010 和 2015 登记处的数据，三项全国性的法国调查，我们纳入了所有在 症状出现24小时内接受过直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者。根据冠状动脉状态（单支、两支和三支血管病变）分析基线特征、管理和 3 年全因死亡率。

结果

3907例患者（平均年龄62.4  ±  13.7岁；75.9%为男性）中，多支病变（二支或三支病变）占47.9%；总体而言，他们年龄较大，心血管风险较高。在多变量调整的 Cox 比例风险回归模型中，只有三支血管病变患者的 3 年死亡率高于单支病变患者（风险比 1.52，95% 置信区间 1.68-2.26；P  <  0.001 ）。最后，出院前完全心肌血运重建的多支血管病变患者与单支血管病变患者的预后相似（风险比 1.17，95% 置信区间 0.84-1.64；P  =  0.35）。

结论

多支血管病变仍占 ST 段抬高型心肌梗死患者的重要比例。尽管三支血管病变与较高的 3 年死亡率相关，但当代多支血管病变和完全心肌血运重建患者的 3 年死亡风险与单支病变患者相似。