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Abstract Objective: The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention. Methods: This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality. Results: Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy. Conclusions: OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.
Resumen Objetivo: El propósito fue comparar resultados de pacientes con infarto agudo de miocardio con elevación del segmento ST y enfermedad coronaria multivaso sometidos a revascularización completa de un solo momento frente a revascularización completa por etapas mediante intervención coronaria percutánea. Métodos: Estudio cohorte observacional, retrospectivo, unicéntrico, con datos de enero de 2013 a abril de 2019, incluyendo 634 pacientes. Se compararon resultados entre pacientes sometidos a revascularización completa por etapas frente a revascularización completa en un solo momento. El objetivo primario fue valorar mortalidad intrahospitalaria por cualquier causa y como objetivos secundarios se evaluaron a 30 días y 1 año las complicaciones cardiovasculares, hospitalizaciones y mortalidad. Se construyó un modelo de regresión logística para determinar los factores de riesgo que predijeron mortalidad. Resultados: De 634 pacientes, 328 fueron tratados con revascularización por etapas y 306 con revascularización en una intervención. El 76.7% fueron hombres, con una media de edad de 63.3 años. En el grupo de revascularización de un solo tiempo se encontraron lesiones coronarias menos complejas y una mayor proporción de la arteria descendente anterior como vaso culpable. Comparado con el grupo de revascularización por etapas, los objetivos primarios y secundarios ocurrieron con menos frecuencia en el grupo de revascularización en un solo tiempo. Conclusiones: Comparada con la revascularización intrahospitalaria por etapas, la revascularización en una intervención lleva a mejores desenlaces clínicos sin generar más complicaciones.
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Objective • To summarize the experiences and follow-up results of minimally invasive direct coronary artery bypass (MIDCAB) for treating coronary atherosclerotic cardiopathy for 10 years and to evaluate the long-term effects of MIDCAB. Methods • The patients who underwent MIDCAB at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from February 2009 to May 2019 were collected. According to whether the patients achieved complete revascularization (CR) or underwent hybrid coronary revascularization (HCR), the cases were divided into 3 groups: incomplete revascularization (IR) + optimal medical therapy (OMT) group, MIDCAB (CR) group and HCR (CR) group. The Kaplan-Meier (K-M) curve was used to analyze the long-term survival and the freedom from major adverse cardiac and cerebrovascular events (MACCE) of patients. Results • A total of 425 patients were enrolled in the study, with a median follow-up of 39.9 months (18.2-81.1 months). The hospital stay in the HCR (CR) group was significantly prolonged compared with the other two groups (P=0.000). The perioperative mortality (P=0.000), perioperative myocardial infarction (MI) rate (P=0.000), perioperative MACCE rate (P=0.000), cardiac troponin I (cTnI) levels in 48 h (P=0.011), long-term mortality (P=0.000), long-term MI rate (P=0.002), and long-term MACCE rate (P=0.005) in the IR + OMT group were significantly higher than those in the other two groups of patients who had CR. The overall 10-year survival rate and freedom from MACCE estimated by K-M curves were 80.9% (95%CI 73.1%-88.7%) and 70.5% (95%CI 62.1%-78.9%), respectively. The long-term survival (P=0.000) and freedom from MACCE (P=0.001) in IR+OMT group were significantly lower than those in the other two groups. Conclusion • MIDCAB has good long-term effects on patients with coronary atherosclerotic cardiopathy. Patients undergoing MIDCAB should complete CR, and IR can significantly affect the long-term prognosis of patients.
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Objective To explore the effect of percutaneous coronary intervention(PCI) revascularization degree on exercise tolerance in the patients with multivessel coronary heart disease(CHD).Methods Ninety-three cases of coronary multivessel disease undergoing PCI revascularization and completing the cardiopulmonary exercise testing(CPET) were selected and divided into the complete revascularization group(CR group) and incomplete revascularization group(ICR group).The patients' general condition,co-existence diseases,medication,CHD and vessel lesion situation,echocardiography and CPET results at revascularization and within 1 week of CPET in the two groups were collected.Then the exercise tolerance was evaluated and compared between the two groups.Results The peak metabolic equivalent in the CR group and ICR group were 6.1(3.0-11.0) Mets and 6.3 (3.0-9.0) Mets;the VO2 at anaerobic threshold were 16.3(4.0-23.0) mL · kg-1 · min-1 and 15.9(4.0-26.0) mL · kg-1 · min-1,respectively;the peak VO2 were 21.1(13.0-35.0) mL · kg-1 · min-1 and 21.9(13.0-31.0) mL · kg-1 · min-1,respectively(P=0.919,0.350,0.991).Conclusion For the patients with multivessel CHD receiving ICR,their exercise tolerance is not inferior to those receiving CR.
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Objective To investigate the effect of complete revascularization strategy on the prognosis of elderly patients suffering from acute ST-segment elevated myocardial infarction(STEMI)complicated with multivessel disease(MVD). Methods A total of 390 elderly patients(over 60 years old)suffering from acute STEMI with MVD treated by clinical revascularization administration were enrolled for the study and divided into complete revascularization group(CR group,n=139)and non-complete revascularization group(NCR group,n=251). The effect of complete re-vascularization strategy on the prognosis was then analyzed by COX regression analysis. Results Compared with the NCR group,the patients of the CR group are younger and with a higher ratio of old myocardial infarction ,as well as the average number of stents ,and the mean value of total stent length is larger. The application of calcium channel blocker for post-operation patients is rarer as well. No significant difference can be found between the two groups on the ratio of post-operation all-cause mortality,cardiac mortality,nonfatal myocardial infarction,unplanned repeat revas-cularization. Multivariate COX analysis showed that the complete revascularization had no obvious difference on the prognosis of these patients be-tween the two groups. Conclusion There is individual diversity in the revascularization strategy choosing for elderly patients of acute STEMI alongside MVD;however,the prognosis is not significantly improved.
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Objective To investigate the effect of percutaneous cardiac intervention (PCI) on the clinical prognosis in aged patients with coronary heart disease (CHD) involving multiple coronary arteries who obtained complete revascularization (CR) or incomplete revascularization (ICR) after PCI.Methods A total of consecutive 257 aged patients (＞75 years old) with confirmed CHD that involved multiple coronary arteries,who were admitted to authors' hospital during the period from January 2015 to September 2015 to receive PCI,were enrolled in this study.Based on the complete revascularization (CR) or incomplete revascularization (ICR) after PCI,the patients were divided into CR group and ICR group.The basic clinical data,PCI parameters and the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in hospitalization days and in the follow-up period were compared between the two groups.Results CR group included 171 patients (66.53％) and ICR group included 86 patients (33.47％).The hypertension history,diabetes history,diagnosis of acute non-ST segment elevation myocardial infarction or myocardial occlusion disease at admission,chest tightness,palpitation and other discomfort symptoms occurring in one and 3 months after PCI,and re-hospitalization rate in ICR group were significantly higher than those in CR group (P＜0.05).No statistically significant differences in the incidence of MACCE during hospitalization days and at one,3 and 6 months after PCI existed between the two groups (P＞0.05).Conclusion In aged patients with CHD that affects multiple coronary arteries,ICR does not increase the risk of MACCE after PCI,although the re-hospitalization rate and the incidence of postoperative discomfort symptoms will be increased.The long-term prognosis needs to be further studied.
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Objective To evaluate the effect of SYNTAX score in the emergency revascularization strategy selection in ST‐segment elevation myocardial infarction patients with multi‐vessel disease(MVD) and to analyze the patient′s prognosis and influen‐cing factors .Methods A total of 144 patients with STEMI complicating MVD verified by coronary arterial angiography in the Xin‐qiao Hospital of Third Military Medical University from August 2010 to March 2012 were collected and divided into the once com‐plete revascularization group (CR group) ,staged complete revascularization group (SR group) and incomplete revascularization group (IR group) according to different emergency PCI strategies .The basic clinical conditions and coronary arterial SYNTAX score were recorded .The occurrence rate of major adverse cardiovascular events (MACCE) during 12 months follow up period was performed the statistics .The results of coronary arterial angiography were collected .The effect of different strategy on prognosis and the risk factors affecting prognosis were analyzed .Results There was no statistically significant difference in the all‐cause mor‐tality between the IR group with the CR and SR groups (P>0 .05) ,while the cerebrovascular event ,repeat revascularization during hospitalization ,AMI and total MACCE occurrence rate had statistical difference between the IR group with the CR and SR groups (P 0 .05) ,while which in moderate lesion had statistical difference among 3 groups(P<0 .05) ,the CR group had the highest occurrence rate of MACCE . Conclusion For the patients with STEMI complicating MVD ,the SYNTAX score can be used as the evidence for selecting reperfu‐sion strategies and applied in emergency PCI .