Different Initial Treatment Strategy For The Prognosis Of Acute Myocardial Infarction

Objectives:To compare the effects of the different strategy of treatment in patients with acute myocardial infarction, including drug conservative, emergency PCI and elective PCI on the outcome andprognosis of the patients.Methods:This study was conducted in our hospitals. A total of 571 consecutive patients with AMI between Jan.2005 and Dec.2011 were enrolled. Among,285 patients received drug conservative treatment,46 received emergency PCI and 240 received elective PCI. Patients were followed up In Oct 2015.Results:At baseline, the age of patients in the drug conservative treatment group [(73.2±10.8)years]was significantly higher than those in the emergency PCI group[(62.6±11.8) years]and in the elective PCI group [(63.5±10.6)years, all P<0.01];the heart rate of patients at the admission in drug conservative treatment group[(85.0±24.7)bpm]was significantly higher than those in the emergency PCI group[(74.2±13.8)bpm] and in the elective PCI group [(76.5±15.7)bpm, all P<0.01].The incidence of the cardiac dysfunction (Killp class>Grade2) in the drug conservative treatment group(109/285,38.2%) was significantly higher than in the emergency PCI group(3/46,6.5%)and elective PCI group(45/240,18.8%, all P<0.01).the median time from symptom onset to hospital in the emergency PCI group(2.5 hour)was significantly shorter than those in the drug conservative treatment group(12 hour)and elective PCI group(11 hour, all P<0.01).The in-hospital mortality and the all-cause mortality after hospital discharge were significantly higher in the drug conservative treatment group[25.3%(72 /285)and 57.3%(43/75)]than in the emergency PCI group[8.7%(4/46),3.8%(1/26)]and in the elective PCI group[1.7%(4/240),14.3%(15/105), all P<0.01]. The new onset of heart failure in hospital discharge in drug conservative treatment group[41.4%(117/285)] was more than that in emergency PCI group[15.2%(7/46)]and the elective PCI group[25.4%(61/ 240),all P<0.01]. The Hospitalization for subsequent acception of revascularization (PCI or CABG) ratio was significantly higher in the emergency PCI group [42.3%(11/26)]than in the drug conservative treatment group [4.0%(3/75)]and in the elective PCI group[19.0%(20/ 105), all P<0.01]. At the end of follow-up, the patients in the emergency PCI group had the highest adherence level of statins treatment. Multivariable Cox proportional hazards regression analysis showed that compared with the drug conservative treatment group, the emergency PCI (HR=0.21,95%CI:0.08～0.52, P<0.01)and the elective PCI (HR=0.43,95% CI:0.33～ 0.57, P<0.01)was associated with the lower risk of all-cause mortality in the patients with myocardial infarction. The survival of patients in the emergency PCI group and the elective PCI group was significantly improved compared with the drug conservative treatment group (all P<0.01).Conclusions:1. In clinical practice, PCI therapy plays a critical role to improve the prognosis of patients with acute myocardial infarction, especially for older and less rapid heart rate, cardiac function of patients on admission recommendations should be more aggressive.2. Patients at first acceptance of PCI therapy were likely to continue to influence the attitudes and results of treatment options during follow-up.3. AMI patients should be fully strengthen the long-term follow-up and management, patient’s adherence to the doctor’s advice.