對於 ST 段上升之急性心肌梗塞，緊急心導管手術 “一次搞定”多 …

1 ST .. (culprit artery- ST (STEMI) only revascularization) . (30 . 3. 2012 ) (Figure 1) . 1. (2012 ESC Guideline) 2013 (multivessel (2013 ACCF/ AHA revascularization) . 2. Guideline) (repeat PCI) . (Primary PCI) (CABG) (Major Adverse (non-infarct or non-culprit arteries) (Class III Cardiovascular Events, MACE) (Figure 4. recommendations) 2) . Primary PCI non- infarct arteries . Preventive Angioplasty in Acute Myocardial Infarction 5. (PCI) (PRAMI) trial . (CABG) . (staged revascularization) PRAMI trial 2008 . Primary PCI 2013 465 . PCI CABG non-infarct acute STEMI . arteries (noninfarct arteries 50% 50% . ) infarct arteries Infarct artery-only 3,4. meta-analysis studies PCI ( noninfarct arteries ). Primary PCI non-infarct arteries Preventive PCI ( noninfarct 2 102 9.)

2 Figure 1. Odds ratios for 30-day mortality. arteries) (repeat revascularization procedures, PCI or CABG) 234 . Preventive PCI 231 . Infarct artery-only PCI . (CABG) noninfarct arteries . ( . CABG ) noninfarct arteries chronic total occlusion ( PCI . ) 2013 1 . Primary outcomes primary outcomes . (P< ) Preventive PCI . Secondary outcomes 21 primary outcomes Infarct 3.. Figure 2. Risks of long-term (A) mortality and (B) major adverse cardiovascular events. 4 102 9 .. artery-only PCI 53 primary dial infarction refractory angina repeat revas- outcomes Preventive PCI 14% cularization cardiac death . (hazard ratio, ; 95% [CI], (P = ) . to ; P< ) ( Figure 3) . hazard ratio Preventive PCI . (95% CI, to ; P = ) . (Table 1) 6 preventive PCI . nonfatal myocar.

3 95% .. (Primary PCI) . noninfarct arteries . 6,7. ( . HELP AMI trial) preventive PCI . revascularization primary Figure 3. Kaplan Meier Curves for the Primary outcomes . Outcome. 5.. PRAMI trial vascularization vs. culprit only primary angio- plasty in patients with ST-elevation myocardial 8 9. infarction and multivessel disease: a meta-anal- CVLPRIT trial DANAMI-3 trial ysis. J Thromb Thrombolysis. 2011;31:217-25. preventive 4. Bangalore S, Kumar S, Poddar KL, et al. Meta- PCI analysis of multivessel coronary artery revas- cularization versus culprit-only revasculariza- Fractional Flow Reserve (FFR) . tion in patients with ST-segment elevation noninfarct arteries myocardial infarction and multivessel disease. Am J Cardiol. 2011;107:1300-10. (Primary PCI) 5.

4 Wald DS, Morris JK, Wald NJ, et al. Ran- domized Trial of Preventive Angioplasty in . Myocardial Infarction (PRAMI). N Engl J Med 2013 Sep 1. 6. Di Mario C, Mara S, Flavio A, et al. Single vs multivessel treatment during primary angio- plasty: results of the multicenter randomised 1. The Task Force on the management of ST- Hepacoat for culprit or multivessel stent- segment elevation acute myocardial infarction ing for Acute Myocardial Infarction (HELP. of the European Society of Cardiology (ESC). AMI) Study. Int J Cardiovasc Intervent 2004;. ESC Guidelines for the management of acute 6:128-33. myocardial infarction in patients present- 7. Politi L, Sgura F, Rossi R, et al. A randomized ing with ST-segment elevation. Eur Heart J trial of target-vessel versus multi-vessel revas- 2012;33:2569-619.

5 Cularisation in ST-elevation myocardial infarc- 2. O'Gara PT, Kushna FG, Ascheim DD, et al. tion: major adverse cardiac events during long- 2013 ACCF/AHA Guideline for the Manage- term followup. Heart 2010;96:662-7. ment of ST-Elevation Myocardial Infarction: 8. Complete Versus culprit-Lesion only Primary Executive Summary: A Report of the Ameri- PCI Trial (CVLPRIT): a multicentre trial test- can College of Cardiology Foundation/Ameri- ing management strategies when multivessel can Heart Association Task Force on Practice disease is detected at the time of primary PCI. Guidelines. Circulation 2013;127:529-55. 9. Danish study of optimal acute treatment of pa- 3. Navarese EP, De Servi S, Buffon A, et al. tients with ST-elevation Myocardial Infarction Clinical impact of simultaneous complete re- 3 (DANAMI-3) trial.

6 6 102 9.