| BackgroundThe prognosis of AMI depends on the time of reperfusion therapy, the size of infarct area and the establishment of collateral circulation. The overwhelming majorities of AMI patients present at least one-vessel disease while certain quantities of patients have clinically significant stenosis in all three vessels. The main initiating mechanism of AMI is plaque rupture or erosion with overlying thrombosis in infarct related artery (IRA). Though non-IRA is not considered to be the main cause of AMI, we are not sure whether it will increase the mortality and major adverse events in AMI patients. We aim to clarify this impact on1-year outcome of acute myocardial infarction from the aspect of the number of vessel diseased.MethodThe AMI patients who received coronary angiography from January2009to November2011in Sir Run Run Shaw hospital were enrolled and followed up for1year. Patients were evaluated at baseline for clinical characteristics and the treatment strategies during the hospitalization. Follow-up data were collected at the time of3 month (3±1months) and1year (12±3months) following discharge. The combining endpoint was the occurrence of major adverse cardiac and cerebrovascular events (MACCE), which was a composite of fatal MI, fatal stroke, other cardiovascular death, non-fatal MI, non-fatal stroke and hospitalization for revascularization. According to the number of vessel diseased, all patients were divided into4groups:negative, single-vessel, double-vessel and triple-vessel. In the survival analysis, cumulative MACCE-free survival rates over1-year follow-up period were estimated using the Kaplan-Meier method. The independent risk factors of MACCE were assessed using a multivariate Cox proportional hazards model.ResultsA total of493patients were assessed, among whom39(7.9%) were involved in left main (LM),421(85.4%) were involved in left anterior descending (LAD),270(54.8%) were involved in circumflex (CX),305(61.9%) were involved in right coronary artery (RCA).279(56.6%) had hypertension and132(26.8%) had diabetes mellitus. Multi-vessel vs. single-vessel:age (64.1vs.59.2, P=0.000), hypertension (59.9%vs.48.9%, P=0.031), diabetes mellitus (30.6%vs.17.3%, P=0.003), history of stoke (8.1%vs.1.4%, P=0.006), HbAlc (6.6vs.6.2, P=0.044), LDL-C (2.00vs.1.83, P=0.044).At1-year follow up,72(16.5%) patients had MACCE. Multi-vessel vs. single-vessel:1-year cumulative rate of MACCE (19.5%vs.10.1%, P=0.013), revascularization (11.8%vs.5.8%, P=0.049). COX regression (multivariate analysis): multivessel lesions (HR:2.445,95%CI:1.028-5.815, P=0.043), post-PCI eGFR<60ml·min-1·1.73m-2(HR:4.245,95%CI:1.405-12.827, P=0.010), history of stroke (HR:3.250,95%CI:1.202-8.787, P=0.020). Post-PCI eGFR<60ml·min-1.73m-2vs. post-PCI eGFR≥60ml·min-1·1.73m2:1-year cumulative rate of MACCE (37.9%vs. 13.4%, P=0.000),1-year all cause mortality (25.9%vs.2.2%, P=0.000), fatal MI (19.0%vs.1.6%,P=0.000).Conclusion1) For the entire patient group,56.6%of patients had hypertension,26.8%had diabetes mellitus, LAD was involved in most of the patients, then RCA, CX and LM.2) In the comparison of subgroups, patients with multi-vessel disease tended to be older and have more concomitant disease, including diabetes, hypertension, and previous history of stoke.3) The multi-vessel disease and post-PCI eGFR were both risk factors for1-year outcome of AMI and predicted poor prognosis in Chinese patients.4) At1-year follow up, the cumulative incidence of MACCE was16.5%. The1-year incidence of MACCE was significantly higher in patients with multi-vessel disease than single-vessel disease, especially the revascularization rate.5) Comparatively, post-PCI eGFR<60ml·min-1·1.73m-2had a higher rate of1-year MACCE and all cause mortality, which was largely due to fatal MI. |
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