The Effects Of Complete Revascularization In The Early Stage Of Acute Myocardial Infarction

Objective:The optimal percutaneous interventional strategy for dealing with significant non-culprit lesions in patients with acute myocardial infarction(AMI) in multivessel disease(MVD) still remains controversial.In the study,we evaluated the clinical outcomes of complete revascularization in patients with AMI in multivessel disease.Besides,multivessel PCI early after AMI is discouraged because of the potential for increased complications.However,with recent advances in PCI,the safety and long-term outcomes of multivessel PCI are unknown.We evaluated the outcomes of multivessel PCI early after AMI.Methods:A total of 802 patients with AMI treated with primary PCI at acute stage(within 12 hours) between 2003 and 2008 were divided into single-vessel disease group(SVD group) and multivessel disease group(MVD group);and then,the patients in MVD group were subdivided into 2 groups:1) patients with incomplete revascularization(MVD_ICR group);2) patients with complete revascularization in early stage(MVD_CR group).Then,patients in MVD_CR group were subdivided into 2 groups:1) patients undergoing PCI of the infarct-related artery(IRA) only at acute stage(CR_IR group);2) patients undergoing multivessel PCI at acute stage(CR_MV group).The primary end points were the occurrences of one-year death and major adverse cardiac events(unstable angina pectoris,nonfatal reinfarction,heart failure, malignant arrhythmia and target revascularization).Results:①Compared with patients with single-vessel disease,patients with multivessel disease had higher incidence of 1-year death(7.0%vsl.4%,p＜0.05) and major adverse cardiac events including unstable angina pectoris(20.4%vs10.7%, p＜0.05),reinfarction(2.8%vs0.9%,p＜0.05),revascularization(7.0%vs0.9%,p＜0.05) and.heart failure(13.3%vs3.8%,p＜0.05) Multivessel disease was the strong predictor of 1-year death of the patients with AMI.②Compared with patients with incomplete revascularization,patients with complete revascularization had a lower incidence of mortality(0.9%vs8.8%,p＜0.05),heart failure(2.8%vs16.5%,p＜0.05) and malignant arrhythmia(5.7%vs18.8%,p＜0.05) within 1 year follow-up.There were no significant differences between two groups in unstable angina pectoris(15.1%vs21.9%,p＞0.05), nonfatal reinfarction(1.9%vs3.1%,p＞0.05),and revascularization(7.5%vs6.8%, p＞0.05).By multivariable analysis,the presence of incomplete revascularization was the strong predictor of 1-year death of the patients with AMI in MVD.③CR_IR group and CR_MV group were balanced in terms of clinical characteristics,number of diseased vessels and angiographic characteristics of culprit lesion.And,a similar low incidence of death(0%vs1.3%,p＞0.05) and major adverse cardiac events including unstable angina pectoris(15.4%vs 15.0%,p＞0.05),reinfarction(3.8%vs1.3%,p＞0.05), revascularization(7.7%vs7.5%,p＞0.05) and.heart failure(3.8%vs2.5%,p＞0.05) were observed in the 2 groups.Conclusions:①This study suggests that complete revascularization in early stage for the patients of AMI with multivessel disease may exert a beneficial effect on long-term prognostics.②Early multivessel PCI would be effective and safe in patients with AMI.