Effects Of Different Revascularization Strategies For Non-infarct Related Artery On Prognosis In Patients With STEMI Multivessel Disease

Objective: To investigate the effects of different revascularization strategies on prognosis of patients with ST-segment elevation myocardial infarction(STEMI)complicated with multivessel disease after successful opening the infarct-related artery during the primary percutaneous coronary intervention(PCI).Methods: We retrospectively analyzed 227 cases of patients with STEMI and multivessel disease who were admitted to the cardiovascular Department of Jinling Hospital from January 1,2014 to December 31,2016.Infarct-related arteries in all patients were revascularized after the primary PCI.According to different revascularization strategies for non-infarct related vessels,patients were divided into revascularization of culprit vessel only group(CO,164 cases),immediate multivessel revascularization group(I-MVR,39 cases),and staging multivessel revascularization group(S-MVR,24 cases).The baseline clinical characteristics,PCI characteristics and medication during hospitalization of the three groups were recorded.The primary endpoint was major adverse cardiac events(MACE)after the primary or second PCI,including cardiac death,myocardial infarction and unplanned revascularization.Secondary endpoints included all-cause death,refractory angina,cardiogenic readmission,and components of MACE.Cumulative incidence was estimated with the Kaplan Meier method,three groups were compared with the use of log-rank test.We used logistic regression models to assess the effect of variables on the endpoints.Results: There were no significant differences in baseline clinical characteristics,medication during hospitalization and PCI characteristics among the three groups.After mean follow-up of 58.4 months,there was a significant difference in the incidence of MACE between the CO group,the I-MVR group and the S-MVR group(39.6% vs.28.2% vs.12.5%,P=0.021).The incidences of unplanned revascularization(30.5% vs.20.5% vs.8.3%,P=0.047),refractory angina(34.8% vs.17.9% vs.12.5%,P=0.018)and cardiac readmission(57.3% vs.43.6% vs.33.3%,P=0.043)of CO group were significantly higher comparing to the other two groups.There was no significant difference in the incidences of all-cause death(13.4% vs.7.7% vs.8.5%,P=0.566),cardiogenic death(10.4% vs.7.7% vs.4.2%,P=0.617)and myocardial infarction(7.3% vs.12.8% vs.0%,P=0.163)among the three groups.Logistic regression models showed that revascularization of culprit vessel only,female,renal insufficiency,culprit vessel of left anterior descending coronary artery and three-vessel coronary artery disease were the risk factors for MACE.Conclusion: After successful revascularization of infarct-related arteries in STEMI patients with multivessel disease by the primary PCI,staged revascularization of non-IRA can significantly reduce the risk of MACE and improve long-term prognosis,comparing to intervention during the primary PCI or no further intervention.The reduction of MACE was mainly driven by less unplanned revascularizations.The intervention of infarct-related artery only was an independent risk factor for MACE in STEMI patients with multivessel disease.