Effects and safety of primary percutaneous coronary intervention for both infarct and non-infarct-related artery in patients with acute ST-segment elevation myocardial infarction and multivessel disease

Abstract

Objective The purpose of this study was to investigate the feasibility and safety of treatment for both infarct and non-infarct-related artery in patients with acute ST-segment elevation myocardial infarction(STEMI) and multivessel disease(MVD) during primary percutaneous coronary intervention(PCI) procedure and its effectiveness in the one year follow-up period. Methods A total of 221 eligible patients with acute STEMI and at least with two major diseased coronary arteries (luminal stenosis≥75%) underwent primary PCI were included, the mean age was 57.9±12.0(32-82) years old.Of them, 179 patients underwent primary PCI for infarct-related artery (IRA) only (group routine), and 42 patients received primary PCI for non-IRA at the same time of IRA were treated successfully (group treatment). Drug-eluting stent (DES) were used in all the patients. Then to compare the differences of the time of hospital, symptom of angina pectoris after the primary PCI, the rates of re-revascularization and the readmission, cardiac function in the follow-up period and the major adverse cardiac events (MACE, such as death of cardiac, nonfatal reinfarction) between the two groups. Results There were no differences in clinical characteristics (such as age, sex, body mass index, LDL-C, blood glucose, serum creatinine, the history of smoking, diabetes mellitus and hypertension, the time from symptom emerge to balloon dilatation) between the two groups (P>0.05). Similar rates of MACE at one year follow-up period were observed in the two groups(4.76% vs. 2.79%, χ2=0.03, P=0.87). But recurrent angina pectoris(40.48% vs. 60.34%, χ2=5.46, P=0.02), the rates of re-revascularization(9.52% vs. 58.10%, χ2=32.13, P=0.00) and the readmission(11.90% vs. 27.93%, χ2=4.68, P=0.03) were all lower in the treatment group than that of the routine group(P<0.05), the cardiac function is better in the treatment group than that of the routine group in the follow-up period [(1.19±0.59)grade vs. (1.49±0.89)grade, t=2.66, P=0.01]. Conclusions Both IRA and non-IRA revascularization using DES in patients with STEMI and MVD could reduce the symptom of angina pectoris, the rates of re-revascularization and the readmission, improve the cardiac function, and did not increase the MACE in the period of follow-up after the primary PCI, therefore, we think that non-IRA PCI can be used as a selection of primary PCI in patients with acute STEMI and MVD. Key words: Angioplasty, transluminal, percutaneous coronary; Acute ST-segment elevation myocardial infarction; Non-infarct-related artery; Multivessel disease; Prognosis