Comparison Of The Ptognosis Of Three Treatment Strategies In Patients With Multivessel Coronary Artery Disease

Objective:1.A retrospective comparison of the prognosis of three different treatment strategies innon-acute myocardial infarction patients with three-vessel or in combination with left maincoronary artery disease：medical therapy alone、Percutaneous coronary intervention (PCI)、Coronary artery bypass grafting (CABG).2.A retrospective comparison of the prognosis of above three different treatmentstrategies in non-acute myocardial infarction patients with three-vessel disease in theabsence of left main coronary artery disease.3.A retrospective comparison of the prognosis of above three different treatmentstrategies in acute myocardial infarction patients with three-vessel or in combination withleft main coronary artery disease.Methods:1. From January2011to May2013,a total of464patients with coronary angiographyshowed three-vessel or in combination with left main coronary artery disease werecontinuously screened retrospectively in the Fourth People’s Hospital of Ji’nan City, whichdivided into non-acute myocardial infarction group(n=209) and acute myocardialinfarction group(n=255) according to their admitting diagnosis. Demographic profile、history of present illness、past medical history、personal history、laboratory and otherauxiliary examination results、coronary angiography and therapeutic method of each groupwere recorded respectively. Patients were followed up by telephone enquiries or out-patientor in-patient medical consultation. The primary clinical end point was a composite ofmajor adverse cardiac and cerebrovascular events(MACCE：death from any cause, stroke,myocardial infarction and repeat revascularization). The secondary end point was the rateof patients required re-hospitalization for cardiac reasons. Patients in the non-acute myocardial infarction group and the acute myocardial infarction group were respectivelydivided into three groups according to their treatment strategy: medical therapy group、intracoronary drug-eluting stent implantation group（DES group） and CABG group, andthe prognosis were compared by different treatment strategies.2.Patients with three-vessel disease in the absence of left main coronary artery diseasewere divided into the above three groups according to their treatment strategy, and theprognosis were compared by different treatment strategies.Results:1. Prognostic comparison of different treatment strategies in non-acute myocardialinfarction patients with three-vessel or in combination with left main coronary arterydisease, the total MACCE rate of drug treatment group was the highest, and there was notstatistically significant difference with PCI group’s(P＞0.05)，PCI group’s was higherobviously than CABG group’s(P＜0.05). The CABG group was the lowest in the rate ofdeath and myocardial infarction，but there were no differents between the three groups’(P＞0.05). The rate of stroke of PCI group was the lowest,and hightest in the CABGgroup’,but there were also no differents between the three groups’(P＞0.05). Therevascularization rate of PCI group was higher obviously than CABG group’s(P＜0.01),and was similar with drug treatment group’s(P>0.05)，drug treatment group’s was alsohigher than CABG group’s(P＜0.05). The rate of patients required re-hospitalizationbecause of cardiac reasons in the drug treatment group was highter than PCI group’s(P＜0.05),PCI group’s was highter obviously than CABG group’s(P＜0.05).2. Prognostic comparison of different treatment strategies in non-acute myocardialinfarction patients with three-vessel disease in the absence of left main coronary arterydisease, The rate of total MACCE、death、myocardial infarction and revascularization ofdrug treatment group was the highest,but were similar with PCI group’s(P＞0.05), Thetotal MACCE rate and revascularization rate of PCI group were highter obviously thanCABG group’s(P＜0.05), the rate of death and myocardial infarction of PCI group werenot statistically significant difference with CABG group’s(P＞0.05). The rate of stroke ofPCI group was the lowest,and hightest in the CABG group’,but there were also nodifferents between the three groups’(P＞0.05). The rate of patients requiredre-hospitalization because of cardiac reasons in the drug treatment group was highter thanPCI group’s(P＜0.05),PCI group’s was highter than CABG group’s(P＜0.05). 3. Prognostic comparison of different treatment strategies in acute myocardialinfarction patients with three-vessel or in combination with left main coronary arterydisease, The rate of total MACCE and death of drug treatment group were the highest,andhighter obviously than PCI group’s(P＜0.05), PCI group’s was similar with CABGgroup’s(P>0.05),but there were no differents between the three groups’(P＞0.05) afterpatients were discharged from the hospital. There were also no differents between the threegroups’(P＞0.05) in the rate of myocardial infarction again and stroke. Revascularizationrate of PCI group was the highest,and was similar with drug treatment group’s(P＞0.05),but was highter obviously than CABG group’s(P＜0.05). The rate of patientsrequired re-hospitalization because of cardiac reasons in the PCI group was not statisticallysignificant difference with drug treatment group’s (P＞0.05),but was highter obviouslythan CABG group’s(P＜0.05).Conclusion：1.In non-acute myocardial infarction patients with three-vessel or in combination withleft main coronary artery disease, except for the rate of patients required re-hospitalizationbecause of cardiac reasons in the drug treatment group was highter than PCI group’s, therate of total MACCE、death、myocardial infarction、stroke and revascularization in the twogroups were similar between the two groups. The total MACCE rate of PCI group washigher than CABG group’s, in large part because of an increased rate of repeatrevascularization in the PCI group. The rates of death、myocardial infarction and strokewere similar between the two groups. The rates of patients required re-hospitalizationbecause of cardiac reasons in the PCI group was higher than CABG group’s.The rates oftotal MACCE and revascularization of the drug treatment group were highter than CABGgroup’s.2. In non-acute myocardial infarction patients with three-vessel disease in the absenceof left main coronary artery disease, the rate of total MACCE、 patients requiredre-hospitalization because of cardiac reasons of drug treatment group was the highest，andlowest in the CABG group’.The rates of death、myocardial infarction and stroke in the PCIgroup were not statistically significant difference with CABG group’s,but the rate ofrevascularization of PCI group was higher than CABG group’s.3.In acute myocardial infarction patients with three-vessel coronary artery disease orin combination with left main coronary artery disease, the rate of total MACCE、death in the drug treatment group was highter than PCI group’s, The latter group’s was similar withCABG group’s, but there were no differents between the three groups’ after patients weredischarged from the hospital.The rates of myocardial infarction again and stroke weresimilar between the three groups.The rate of revascularization in PCI group was thehighest,and was similar with drug treatment group’s,the latter group’s was highter thanCABG group’s. Patients required re-hospitalization because of cardiac reasons was similarbetween the drug treatment group and PCI group, which were highter obviously thanCABG group’s.