Impact Of Different Infarct Coronary Artery On Prognosis Of Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction

Objective:To evaluate the impact of different infarct coronary artery on prognosis of primary percutaneous coronary intervention for acute myocardial infarction.Methods:A total of 183 patients undergoing primary PCI for acute myocardial infarction were divided into three groups according to their different infarcted relative artery:left anterior descending(LAD) group consisted of 84 patients,left circumflex(LCX) group included 36 patients and right coronary artery (RCA) group included 63 patients.Each group were divided into two sub-groups according to their different occlusion site.A lesion was considered proximal if it was located proximal to the first diagonal branch in the left anterior descending coronary artery, the first marginal obtuse branch in the left circumflex coronary artery,and the first right acute marginal branch in the right coronary artery. Lesions distal to these side branches were considered distal.All the patients were followed up for 25.6±7.3 months.The incidence of major adverse coronary events (MACE) during duration of follow-up were recorded.The major adverse coronary events (MACE) included all-cause death,myocardial infarction,revascularization and heart failure.Results : 1. There were no significant differences between LAD group,LCX group,RCA group,and each sub-groups in baseline characteristics such as gender, age, smoking,hypertension,diabetes,hyperlipidemia,blood pressure on admission,time from symptoms to PCI, laboratory outcomes and coronary angiography and so on(P>0.05).2.Heart rate on admission in LAD group was significantly higher than that in LCX group(81.8±13.0 vs 71.7±10.2,P<0.05)and RCA group(81.8±13.0 vs 74.4±13.3, P<0.05),while there was no significant difference between LCX group and RCA group(71.7±10.2 vs 74.4±13.3,P>0.05).Heart rate on admission in LAD proximal sub-group was significantly higher than that in distal sub-group ( 85.3±14.4 vs 76.9±9.0 ,P<0.05),while there was no significant difference between LCX and RCA sub-groups(71.3±6.8vs 72.1±13.3,73.5±11.1 vs 75.5±15.4,P>0.05).3.The incidence rate ofⅢ°AVB in LAD group was significantly lower than that in RCA group(1.2% vs 15.9%,P<0.05),while there were no significant difference between LAD group and LCX group(1.2% vs 8.3%,P>0.05),LCX group and RCA group(8.3% vs 15.9%,P>0.05).There were no significant difference between each sub-groups(P>0.05).4.LVEF on admission in LAD group was significantly lower than that in LCX group(46.4±12.2 vs54.8±10.9,P<0.05)and RCA group(46.4±12.2 vs 56.3±12.7,P<0.05),while there was no significant difference in LCX group an RCA group(54.8±10.9 vs 56.3±12.7,P>0.05).LVEF on admission in LAD proximal sub-group was significantly lower than that in distal sub-group(42.4±10.9 vs 52.9±11.7,P<0.05),LVEF on admission in RCA proximal sub-group was significantly lower than that in distal sub-group(50.8±12.1 vs 60.8±11.7,P<0.05),while there was no significant difference between LCX proximal and distal sub-groups(56.4±11.0 vs 53.5±7.3,P>0.05).5.LVEF in follow-up period in LAD group was significantly lower than that in LCX group(47.5±12.3 vs 58.9±7.3,P<0.05)and RCA group(47.5±12.3 vs 54.8±8.4,P<0.05),while there was no significant difference in LCX group an RCA group(58.9±7.3 vs 54.8±8.4,P>0.05).LVEF in follow-up period in LAD proximal sub-group was significantly lower than that in distal sub-group(43.0±10.7 vs 55.1±11.0,P<0.05),while there was no significant difference in LCX and RCA sub-groups(60.4±10.2 vs 57.7±4.5,53.6±9.9 vs 59.2±9.4,P>0.05).6.There were no significant differences between LAD group,LCX group,RCA group,and each sub-groups in all-cause death,myocardial infarction and revascularization(P>0.05). 7.The heart-failure-free in follow-up period in LAD group was significantly lower than that in LCX group(76.7%±5.2% vs 94.3%±3.9%,P<0.05)and RCA group(76.7%±5.2% vs 91.5%±3.7%,P<0.05),while there was no significant difference in LCX group an RCA group(94.3%±3.9% vs 91.5%±3.7%,P>0.05).The MACE-free in follow-up period in LAD group was significantly lower than that in LCX group(56.8%±6.1% vs 82.0%±7.8%,P<0.05)and RCA group(56.8%±6.1% vs 74.9%±7.3%,P<0.05),while there was no significant difference in LCX group an RCA group(82.0%±7.8% vs 74.9%±7.3%,P>0.05).8.The heart-failure-free in follow-up period in LAD proximal sub-group was significantly lower than that in distal sub-group ( 73.2%±6.4% vs 89.1%±6.1% ,P<0.05 ) ,The MACE-free in follow-up period in LAD proximal sub-group was significantly lower than that in distal sub-group(50.9%±7.2% vs 77.6%±7.7%,P<0.05).Conclusions:1.Compared with LCX and RCA infarction,LAD infarction has been associated with greater left ventricular dysfunction,higher incidence of MACE and poorer prognosis.2.There were no significant differences between LCX infarction and RCA infarction in the composite of all-cause death,myocardial infarction,revascularization and heart failure.3.Compared with distal LAD infarction, proximal LAD infarction has been associated with poorer prognosis.There were no significant differences between proximal and distal infarction in LCX and RCA in the composite of all-cause death,myocardial infarction,revascularization and heart failure.