加拿大麦克马斯特大学Shamir R. Mehta和合作者探讨了运用多支PCI完全血运重建治疗心肌梗死的效果，研究论文9月1日在线发表于《新英格兰医学杂志》.。

研究组招募了ST段抬高型心肌梗死（STEMI）和多支冠状动脉疾病的患者，他们均成功施行罪犯病变经皮冠状动脉介入治疗（PCI）术，将其随机分为两组：2016名患者对血管造影明显的非罪犯病变行PCI术进行完全血运重建（完全血运重建组）；2025名患者则不进一步血运重建（单纯罪犯病变PCI组）。

在3年的中位随访中，完全血运重建组中有158例（7.8%）患者发生心血管死亡或心肌梗死，而单纯罪犯病变PCI组中有213例（10.5%），风险比为0.74。完全血运重建组中有179例患者（8.9%）发生心血管死亡、心肌梗死或缺血驱动的血运重建，而单纯罪犯病变PCI组中有339例患者（16.7%），危险比为0.51。无论非罪犯病变PCI的预期时间如何，均能持续观察到完全血运重建的益处。

研究人员总结说，在STEMI和多支冠状动脉疾病的患者中，完全血运重建与单纯进行罪犯病变PCI相比，可显著降低心血管死亡或心肌梗死以及心血管死亡、心肌梗死或缺血驱动的血运重建的风险。

据悉，在STEMI患者中，对罪犯病变施行PCI可降低心血管死亡或心肌梗死的风险。目前尚不清楚非罪犯病变的PCI是否能进一步降低此类事件的风险。

附：英文原文

Title: Complete Revascularization with Multivessel PCI for Myocardial Infarction

Author: Shamir R. Mehta, M.D., David A. Wood, M.D., Robert F. Storey, M.D., Roxana Mehran, M.D., Kevin R. Bainey, M.D., Helen Nguyen, B.Sc., Brandi Meeks, M.Sc., Giuseppe Di Pasquale, M.D., Jose López-Sendón, M.D., David P. Faxon, M.D., Laura Mauri, M.D., Sunil V. Rao, M.D., Laurent Feldman, M.D., P. Gabriel Steg, M.D., Álvaro Avezum, M.D., Tej Sheth, M.D., Natalia Pinilla-Echeverri, M.D., Raul Moreno, M.D., Gianluca Campo, M.D., Benjamin Wrigley, M.D., Sasko Kedev, M.D., Andrew Sutton, M.D., Richard Oliver, M.D., Josep Rodés-Cabau, M.D., Goran Stankovi?, M.D., Robert Welsh, M.D., Shahar Lavi, M.D., Warren J. Cantor, M.D., Jia Wang, M.Sc., Juliet Nakamya, Ph.D., Shrikant I. Bangdiwala, Ph.D., and John A. Cairns, M.D. for the COMPLETE Trial Steering Committee and Investigators*

Issue&Volume: September 1, 2019

Abstract：

BACKGROUND
In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear.

METHODS
We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization.

RESULTS
At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P=0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001). For both coprimary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI (P=0.62 and P=0.27 for interaction for the first and second coprimary outcomes, respectively).

CONCLUSIONS
Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479. opens in new tab.)