| Backgroud and Objective:The incidence of multi-vessel coronary diseases(MVD)is climbing in recent years with the increase of aged population and the high incidence of hypertension and diabetes.It has been reported that 30% to 60% patients with acute coronary syndrome presented with multi-vessel disease.In clinical practice,PCI is the most commen and important methods of revascularization for the patients with multi-vessel disease.In this clinical setting,complete revascularization and incomplete revascularization are two strategies for doctors.In previous studies and meta-analyzes,the choice of revascularization strategies for patients with multi-vessel disease remains controversial.The accumulated study data and noval coronary medical devices help doctors make more sensible choices in order to improve the prognosis of patients with MVD.Therefore,this study was conducted to investigate the prognosis of patients with acute coronary syndromes and MVD undergoing different revascularization strategies under the existing medical conditions.In addition,we explored the option of different revascularization strategies for elderly and diabetic patients with acute coronary syndromes with MVD in subgroup analysis.Methods:This study was a retrospective clinical analysis with all cases from a single center.A total of 201 patients with acute coronary syndromes and MVD,confirmed by coronary angiography and underwent percutaneous coronary intervention were enrolled in this study from Jan.2014 to Jan.2016,Dandong Municipal Central Hospital.The patients were divided into complete revascularization group(CR group)and incomplete revascularization group(IR group)according to different revascularization strategies.The demographic data,clinical features and laboratory examination results was collected.All of the patients were followed up by telephone from November 2016 to January 2017.The the primary outcome was all-cause death and the secondary endpoint was the composite endpoint of major adverse events,including cardiac death,nonfatal myocardial infarction,unplanned secondary revascularization and stroke.Univariate and multivariate analysis were performed for the relevant factors at the primary and secondary endpoints.Results:1.Comparison of general information: 201 patients were selected in this study.71 patients underwent complete revascularization.Another 130 patients underwent incomplete revascularization.The percentage of acute myocardial infarction,the percentage of non ST-elevation acute coronary syndrome,gender,body mass index,the history of chronic myocardial infarction,the history of cerebral infarction,hypertension,diabetes,smoking history,creatinine,uric acid,total cholesterol,low density lipoprotein cholesterol,triglyceride,high density lipoprotein cholesterol,NT-pro BNP,cardiac function at admission and the use of aspirin,ADP receptor antagonists,statin,angiotensin converting enzyme inhibitors/ angiotensin II receptor antagonists,beta blockers and nitrates during hospitalization were not significantly different between the two groups(P> 0.05).However,the mean age in the IR group was significantly higher than that in CR group(P=0.002).2.Comparison of coronary angiography and interventional vascular condition: the number of blood vessels was 155 in CR group and it was 340 in IR group.The mean number of the blood vessels in IR group was higher than that CR group(3.0 ± 0.8 vs.2.6 ± 1.0,P=0.001).There was no significant difference between the two groups in the mean number of stents for each patient(1.6±0.9 vs.1.4±0.7,P=0.084).Gensini score was higher in IR group than that in CR group(59.3 ± 28.5 vs.50.0 ± 29.2,P=0.012).The percentage of chronic total occlusion in IR group was higher than that in the CR group(9.7% vs.25.9%,P=0.010).There was no difference between two groups in peripheral vascular events(P=0.774).3.Comparison of the events during follow-up: A total of 178 patients including 62 patients in CR group and 116 patients in IR group,completed the follow-up.The mean follow-up time was 24 months,and there was no significant difference between the CR group and the IR group(25.25 ± 6.5 vs.23.98 ± 6.7,P = 0.230).The comparison of the primary outcome: the rate of all-cause death was lower in CR group than that in IR group(1.6% vs.9.5%,P=0.046).The secondary outcome was lower in CR group than that in IR group(14.5% vs.29.3%,P=0.028).The rate of angina recurrence was lower in CR group than that in IR group(16.4% vs.53.3%,P=0.000).4.COX multivariate survival analysis:(1))Complete revascularization(B=-1.017,RR=0.343,95%CI: 0.153-0.766)was a protective factor for the primary endpoint event.Old age(B=0.126,RR=1.135,95%CI: 1.036-1.243)was a risk factor for the primary endpoint event.Complete revascularization(B=-0.951,RR=0.386,95%CI :0.173-0.862)was a protective factor for the secondary endpoint event.History of chronic myocardial infarction(B=0.190,RR=1.209,95%CI:1.051-1.376),history of diabetes(B=0.131,RR=1.140,95%CI:1.008-1.290)and higher Gensini score(B=0.012,RR=1.012,95%CI: 1.002-1.021)were risk factors for secondary endpoint event in the study.5.Subgroup analysis:(1)The prognosis of the elderly patients with acute coronary syndromes and multivessel diseases: 82 patients(including 19 patients in CR group and 63 patients in IR group),aged over 65 completed the follow-up.The comparison of the primary endpoint event: there was no significant difference between two groups on all-cause death rate(5.3% vs.12.7%,P=0.363).There was no significant difference in secondary endpoint event between two groups(44.0% vs.27.0%,P=0.319).The rate of angina recurrence was lower in CR group compared with that in IR group(P=0.003).(2)The prognosis of diabetic patients with acute coronary syndromes and multi-vessel diseases: 54 diabetic patients(22 patients in CR group and 32 patients in IR group)completed the follow-up..The comparison of the primary endpoint event: there was no significant difference between two groups in the rate of all-cause death(4.5% vs.12.5%,P=0.322).The difference in secondary endpoint event was not significant between two groups(18.2% vs.34.4%,P=0.192).However,the incidence of recurrent angina pectoris was lower in the CR group than that in the IR group(P=0.000).Conclusion:(1)In comparison with IR,CR improves the symptoms and the prognosis for patients with acute coronary syndromes and multi-vessel diseases.(2)For the elderly patients with acute coronary syndromes and multi-vessel diseases,CR can not further improve the prognosis in comparison with IR.Therefore,it is feasible for elderly patients with multi-vessel diseases to choose IR strategy.(3)For diabetic patients with acute coronary syndromes and multi-vessel diseases,CR and IR lead to similar prognosis.However,in comparison with IR,CR can significantly improve the symptoms.(4)The strategy of complete revascularization is associated with lower all-cause death rate and the composite endpoint of major adverse events,in comparison with incomplete revascularization.The history of chronic myocardial infarction,history of diabetic and higher Gensini score are risk factors for the composite endpoint of major adverse events in the study. |
