Abstract
The influence of multivessel coronary artery disease on the outcome of reperfusion therapy for myocardial infarction has not been fully characterized. Direct coronary angioplasty without antecedent thrombolytic therapy was performed during evolving myocardial infarction in 285 patients with multivessel coronary artery disease at 5.2 ± 4.2 h after the onset of chest pain. Two vessel disease was present in 163 patients (57%) and three vessel disease in 122 (43%). An anterior infarct was present in 123 patients (43%), cardiogenic shock in 33 (12%) and age ≥70 years in 59(21%).Angioplasty of the infarct-related vessel was successful in 256 patients (90%), including 92% with two vessel and 88% with three vessel disease (p = NS). Emergency bypass surgery was needed in six patients (2%). In-hospital death occurred in 33 patients (12%), including 13 with two vessel and 20 with three vessel disease (p < 0.05). The mortality rate was only 4% in the subgroup of 101 patients who met entry criteria for thrombolytic trials. The in-hospital mortality rate was 45% in patients in shock and 7% in patients not in shock (p < 0.01). Logistic regression analysis identified shock and age ≥70 years as independently associated with in-hospital death.In 135 patients who underwent predischarge left ventriculography, global ejection fraction increased from 50% to 57% (p < 0.001) and regional wall motion in the infarct bone improved in 59% of patients. Follow-up data were available in 251 patients (99%) at a mean of 35 ± 19 months. The actuarial 1 and 3 year survival rate was 92% and 87%, respectively, and was significantly better at both intervals in patients with two vessel disease (p < 0.001).Thus, primary angioplasty in patients with acute myocardial infarction and multivessel disease results in a high reperfusion rate, excellent hospital survival, particularly in patients not in shock, and a favorable long-term outcome.
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