The Prognosis For Early Complete Revascularization In ST-Segment Elevation Myocardial Infarction And Multivessel Coronary Artery Disease

Objective: The purpose of this study was to determine the effect of early complete revascularization(CR)for ST segment elevation myocardial infarction(STEMI)with multivessel coronary artery disease(MVD)on major adverse cardiac and cerebrovascular event(MACCE)after primary percutaneous coronary intervention.Methods: This is a retrospective single-centre study including 197 patients with STEMI with MVD in the cardiovascular medicine of the Affiliated Hospital of Zunyi Medical University from2017-01 to 2019-12.Quarterly calculate the time from Primary PCI to the treatment of Non-IRA lesions,the median was 6 days,and the quartile was 5～8days,So the first 25%,< 5 days were identified as the early group(n =39)and ≥ 5 days as the late group(n =158).The first primary outcome was the composite of cardiovascular death,nonfatal myocardial infarction,Recurrent revascularization and ischemic stroke;the second primary outcome was independent components of MACCE and all-cause death,hospiltalization for heart failure,and bleeding events [Bleeding Academic Research Conortium(BARC)3 or 5] at 2 years.and safety outcome was defined as bleeding events.Results: There was a difference in left ventricular ejection fraction(LVEF)<40%between the two groups,which showed that the number of patients with early was more than that of late group(30.8% vs.16.5%,P =0.042),and the length of hospital stay of early group was less than that of late [(8.0 ± 3.6)vs.(11.0 ± 2.6),P <0.001].Other general clinical data were no statistical significant(P >0.05).There were no significant differences in the crude or adjusted rates of the primary outcome(10.3% early group versus 16.5% late group,crude HR,1.58;95%CI,0.55-4.54;P =0.392;adjusted HR,1.85;95%CI,0.62-5.54);and the second primary outcome were no differences.Cox proportional hazards regression analysis found that diabetes mellitus(HR,2.69;95%CI,1.20-5.99;P =0.015)and LVEF <40%(HR,2.33;95%CI,1.02-5.36;P =0.046)and residual SYNTAX score(HR,1.11;95%CI,1.02-1.22;P =0.019)are independent risk factors for MACCE.Conclusion: Among STEMI with MVD patients who undergo complete revascularization at different times,early group(< 5 days)versus late group(5～90 days)was associated with a similar rate of major adverse cardiac and cerebrovascular event at 2years follow-up.Early CR is safe and reasonable with 5 days(including received Non-IRA revascularization during the primary PCI),the length of stay in hospital are reduced.