The Investigation Of Different Revascularization Strategies For Acute Myocardial Infarction Patients With Multivessel Coronary Disease After Primary Percutaneous Coronary Intervention

Objective: To investigate the effect of different revascularization strategies with non-infarction related artery(non-IRA)for acute myocardial infarction(AMI)patients with multivessel coronary disease(MVD)after primary percutaneous coronary intervention(PCI)of infarction related artery(IRA).Methods: From January 2011 to January 2013,198 AMI patients with MVD were included.According to the random number table,they were randomly distributed to group A(preventive PCI for non-IRA,namely complete revascularization within six to eight day after AMI)and B group(according to the evidence of ischemia operating PCI for non-IRA,namely incomplete revascularization).After succeeding primary percutaneous coronary intervention of infarction related artery,group A and group B were both given the best medical therapy(according to clinical guidelines).And they were followed up for forty-eight months.The major adverse cardiovascular events were MACEs,including cardiac death,myocardial reinfarction,hospitalized from cardiac cases,recurrence of angina pectoris,heart ischemia related re-PCI,heart failure.Results: With forty-eight months followed up,193 cases were completed.There was no significant difference in basic information(Gender,age,hypertension,diabetes,smoking,high cholesterol and coronary lesions).All98 patients preventive PCI managed non-IRA in group A,and five cases hospitalized again from ischemia to intervene non-IRA.All 100 patients PCI managed for IRA in group B,and sixteen cases patients hospitalized again from ischemia to intervene non-IRA.In the group A had 17 recurrence of angina pectoris(18%),5 heart ischemia related re-PCI(5%),21re-hospitalization from cardiac cases(22%),in group B had 35 recurrence of angina pectoris(36%),16 heart ischemia related re-PCI(16%),46re-hospitalization from cardiac cases(47%).The rate of recurrence of angina pectoris,heart ischemia related re-PCI,re-hospitalization from cardiac cases in group A was inferiorer than in group B.Differences between the two groups were statistical significance.The rate of cardiac death,myocardial reinfarction,heart failure was no statistically significant(P>0.05)between the two groups.Conclusion: For acute myocardial infarction patients with multivessel coronary disease,preventive PCI to treat non-IRA for completely revascularization in the early can reduce overall MACEs in comparison to incompletely revascularization,followed up for forty-eight months.Recurrence of angina pectoris,heart ischemia related re-PCI,re-hospitalization from cardiac cases can be mainly reduced.But the rate of cardiac death,myocardial reinfarction,heart failure can not be reduced.