Treatment Timing For Non-infarct-related Artery In Patients With Multi-vessel Disease

BackgroundIn patients with acute myocardial infarction, the patients with multiple vessel diseases accounted for 30%-60%[1]. These patients had at least one severe vascular lesion in addition to the infarct-related vessel. Compared with patients with single vessel disease, the patients with multiple lesions were in critical condition, and had more complications, whose prognosis were worse and the mortality rate was 2 times in 1 year[2]. Current guidelines recommend patients with stable vital signs undergoing percutaneous coronary intervention (PCI) for infarct-related artery only[3-4], but the relative evidence is insufficient, and there are few studies about the best PCI timing for the non-infarct-related artery (Non-IRA) at home and abroad. Thus the treatment strategy is still controversial. In this study, the clinical data of 357 patients with acute myocardial infarction (AMI) and multi-vessel disease (MVD) were collected and followed up. The ideal timing to open the Non-IRA was explored.ObjectiveTo explore the timing of percutaneous coronary intervention (PCI) for non-infarct-related artery in patients with acute myocardial infarction and multi-vessel disease.Materials and methods1. Objective of the research357 patients who were treated in Department of Cardiology of the Provincial Hospital Affiliated to Shandong University in January 2010 to May 2013 with AMI and MVD were included, among them 262 cases were male, and 95 cases were female, whose average age were 59.80 years old.1.1 Selection criteriaAll cases were consistent with the diagnostic criteria of the international definition [5]of myocardial infarction. Enrolled patients must also have:the symptom onset within 12 hours; the coronary angiography confirmed that in addition to the culprit artery associated with at least 1 stenosis> 75% of the main vessel; there were no contraindications to anticoagulation or antiplatelet treatment. Patients underwent rescue PCI after the thrombolysis failure and with left main coronary artery disease or chronic obstructive disease were excluded.2. Grouping methodThese patients were divided into 5 groups according to whether and when they underwent PCI for Non-IRA:117 patients underwent PCI for culprit vessel only (control group); 32 patients underwent PCI for both culprit vessel and Non-IRA at the same time (MV-PCI group); 28 patients underwent PCI for Non-IRA within 7 day(excluding at the time of emergency PCI)(0-7d group); 84 patients within 8-30 days (8-30d group); 96 patients within 31-60 days (31-60d group).3. Data collectionA detailed record of the patient’s medical history, physical examination, laboratory examination, ECG, imaging findings, treatment strategy and clinical outcome was collected in this research. All patients took routine blood test and coagulation function examination before the PCI, and tested the blood lipid^ blood glucose^ serum creatinine and so on in the next morning after emergency PCI. Coronary arteriography and PCI were recorded, including culprit vessels, vascular lesions number and the postoperative outcome.4. Drug therapyAll patients were given aspirin 300mg and clopidogrel 300mg. Treatment of hypertension or diabetes mellitus patients receiving antihypertensive drugs or hypoglycemic agents. During the surgery patients were given heparin l00U/kg, and Tirofiban Hydrochloride as appropriate. The postoperative routine use of aspirin, clopidogrel, statins and so on were required.5. Coronary angiography and PCI implementationThe surgeons used the Holland Philips cardiovascular contrast machine with the Judkins method for the coronary angiography, and used the Seldinger technique to establish arterial access to clear the culprit vessels.Then they made sure the variable types of lesions according to the American College of Cardiology/American College of Cardiology (ACC/AHA) guidelines[6]. Implantation of appropriate drug eluting stents were implemented according to the vascular disease conditions.6. Follow-upOutpatient and telephone follow-up were more used in the research, and the follow-up data mainly included the occurrence of angina pectoris attack and major cardiovascular events (MACE). The primary endpoint was all-cause death within 2 years, and the secondary endpoint was the composite outcome of nonfatal myocardial infarction, heart failure and revascularization. All patients were followed-up for 2 years.7. Statistical methodsData were processed by SPSS 13.0 statistical software.The measurement data were defined as x±s by F test, and the count data were compared by means of the chi-square test. The survival curves were processed by the graphpad 5.0 of prism software in the Kaplan Meier method. The difference was statistically significant between P< 0.05.ResultsThe in-hospital MACE is found to be the highest in the MV-PCI group (18.8%), the lowest in the control group(3.4%), and the second lowest in the 31-60d group(P=0.02), while the rate of MACE at follow-up period is the highest in the control team (59.8%)(P< 0.01) and the cumulative rate of MACE in the 31-60d group is the lowest(18.80%)(P< 0.01).ConclusionsPCI for Non-IRA would be beneficial to improve patients’prognosis, and PCI for both culprit vessel and Non-IRA at the same time is risky. It’s advisable to choose PCI within 31-60 days after the acute myocardial infarction for Non-IRA.