| Objective: To investigate the effects of different timing of arranged second percutaneous coronary intervention(PCI)on left ventricular function and prognosis in patients with coronary multivessel disease(including stable coronary artery disease,STEMI and NSTEMI patients);To analyze the affecting factors to the mid-and long-term prognosis in patients with coronary artery multivessel disease after second PCI.Methods: A total of 982 patients that hospitalized in Department of Cardiology of Affiliated Hospital of Jiangsu University from January 2013 to December 2017,which suffering from coronary artery multivessel disease confirmed by selective coronary angiography(CAG)were involved in this study,and conducted a prospective study on them.These patients,including 596 cases of stable coronary artery disease,218 cases of STEMI and 168 cases of NSTEMI,were underwent arranged secondary PCI.The patients of stable coronary artery disease were further divided into 5 groups according to the interval time(T)of the second PCI: group A:T< 3days;group B: 3 dyas ?T? 6 days;group C: 7 days ?T? 10 days;group D: 11 days?T? 14 days;group E:T? 15 days.The patients of both STEMI and NSTEMI were further divided into 3 groups according to the interval time(T)of the second PCI:group A: 3 days ?T< 7 days;group B: 7 days ?T? 10 days and group C: T> 10 days.And then their long-term prognosis,including left ventricular ejecting fraction(LVEF),survival ratio and major adverse cardiac events were observed through following up.Finally,the clinical baseline data of all groups were compared,and factors may affect the mid-and long-term prognosis of patients with coronary multivessel disease after secondary PCI were explored by multivariate regression analysis.Results:1.The results in patients of Stable coronary artery disease groups: The total difference of ?LVEF value among the five groups was significant(P=0.006)during an average of about 41.85±17.94 months follow-up period.The ?LVEF of five groupwere-0.42±0.47%,0.19±0.26%,2.32±0.71%,-1.09±1.81% and 0.68±1.10%,respectively.The difference of cumulative event-free survival rate among the five groups was significant(75.7%,77.9%,78.4%,45.5% and 56%,respectively.P=0.017).The survival rate without adverse events were significantly higher in C group than other groups(P=0.001).According to Cox proportional risk regression analysis,the factors that affected long-term survival prognosis of stable coronary artery disease patients with multivessel disease after staged PCI included the hypertension history(95% CI:0.423-0.892,P=0.010),level of total cholesterol(95%CI:1.024-1.538,P=0.028),high-density lipoprotein(95% CI:0.197-0.828,P=0.013),and low-density lipoprotein(95% CI:0.478-0.806,P<0.001).2.The results in patients of STEMI groups: The total difference of ?LVEF value among the three groups was significant(P=0.026)during an average of about42.54±15.6 months follow-up period.The ?LVEF of group A,group B,and group C were 2.91±0.79%,0.30±0.58%,-0.12±1.93%,respectively.The difference of cumulative event-free survival rate among the three groups was significant(90.0%,67.2% and 41.2%,respectively.P<0.01).The survival rate without adverse events were significantly higher in group A than group B and group C(group A vs group B,P=0.021;group A vs group C,P=0.010).According to Cox proportional risk regression analysis,the factors that affected long-term survival prognosis of STEMI patients with multivessel disease after staged PCI included the level of total cholesterol(95% CI:1.058-2.783,P=0.029),and low-density lipoprotein(95%CI:0.309-0.924,P=0.025)and serum creatinine(95% CI:0.985-1.030,P=0.013).3.The results in patients of NSTEMI groups: The difference of ?LVEF was significant(P=0.039)among the three groups during the follow-up period of39.85±16.19 months.The ?LVEF value of above three groups was 1.73±0.50%,0.10±0.71%,and-1.57±2.00%,respectively.The difference was also significant in cumulative event-free survival rate of the three groups(87.0%,59.7% and 28.6%,respectively.P=0.01).The survival ratio without adverse events were significantly higher in group A than group B and group C(group A vs group B,P=0.032;group A vs group C,P=0.012).However,Cox proportional risk regression analysis did not find any factor that might affect long-term survival prognosis of NSTEMI patients with multivessel disease after staged PCI.Conclusions: The different timings of staged PCI may affect left ventricularfunction and cumulative event-free survival rate in patients with multivessel disease.Dyslipidemia can increase the risk of middle-to long-term adverse events in STEMI patients. |
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