Comparison Of Medical Treatment And PCI In Patients With Intermediate Coronary Lesions

Objectives:(1)To evaluate the clinical outcomes of patients with intermediate coronary lesions,comparing those who underwent PCI for the intermediate lesion to those who did not(MT);(2)to determine the predictive factors of major adverse clinical cardiac events(MACE)in follow-ups.Methods:A total of 222 patients(mean age 63±10 years),with non-ST segment elevation acute coronary syndrome(UA/NSTMI)who had at last one intermediate coronary lesions(diameter stenosis rate 40-70%)were included in the study.PCI of an intermediate lesion was underwented in a group of 110 patients(PCI group).And the other 112 patients were treated with medical treatment by guideline(MT group).In all patients serious coronary lesions (diameter stenosis rate≥75%)were treated with PCI.MACE(cardiac death, nonfatal myocardial infarction,a need for target lesion revascularization)and the presence of angina were evaluated in follow-ups.Results:There was no difference regarding the mean percent diameter stenosis (54.7±9.3%and 54.6±6.8%,P＜0.01)between the two groups.The clinical features between two groups are similar.Although With the similar secondary prevention of coronary heart disease,quiting smoking,regular exercise,having clopidogrel and statins using,and dyslipidemia controlling were higher in the PCI group compared with MT group(P＜0.05).At a mean follow--up of 30±11 months,the tolal occurrence of MACE and presence of angina were similar between groups.PCI group with moderate TIMI risk has more incidence of TLR than MT group.TIMI risk score is a predictive factor of MACE(hazard ratio 1.38, 95%CI1.057-1.800,P＜0.05).Conclusions:(1)In patients with UA/NSTMI,PCI for intermediate coronary lesions did not reduce the occurrence of angina and MACE,especially in those with moderate TIMI risk.(2)TIMI score is a very powerful predictive factor for long prognosis in UA/NSTMI patients.(3)The secondary prevention of coronary heart disease and medical treatments should be emphasized.