Effect of early intervene in non-culprit vessels on the prognosis of patients with acute ST-segment elevation myocardial infarction presenting with multivessel disease / 解放军医学杂志

ABSTRACT

Objective To explore the effect of drug-eluting stent (DES) implantation for early non-culprit vessel's revascularization on the prognosis of acute ST-segment elevation myocardial infarction (STEMI) patients presenting with multivessel disease (MVD) after percutaneous coronary intervention (PCI). Methods A total of 212 selected patients, admitted in the First Affiliated Hospital of Chongqing Medical University from Jan. 1, 2016 to Jul. 30, 2018, diagnosed as STEMI with MVD undergoing emergency PCI treatment, were recruited in present single-center retrospective study. According to the treatment strategy, all the subjects were then divided into control group (n=153) and experimental group (n=59). Patients in control group received culprit vessel emergency PCI only, and those in experimental group underwent early non-culprit vessel's DES revascularization (Within 14 days of hospitalization) after culprit vessel's PCI. The incidence of major adverse cardiovascular events (MACE, a composite endpoint of cardiac death, recurrent myocardial infarction, ischemia-driven revascularization and heart failure) and safety end point events within 12 months after PCI were compared between the two groups. The influencing factors for MACE were analyzed by logistic regression. Results The incidence of MACE was significantly lower in treatment group than that in control group 12 months after PCI (5.1% vs. 22.2%, P=0.006). No significant statistical difference existed between the two groups in all-cause mortality (0% vs. 5.1%), malignant angina pectoris (1.7% vs. 7.8%), contrast nephropathy (3.4% vs. 2.6%), gastrointestinal bleeding (0% vs. 5.1%), and stroke (3.4% vs. 0.7%). Logistic regression showed that the control group (only received culprit vessel PCI) and prolonged operation time were the risk factors for MACE. Conclusion Early revascularization of non-culprit vessel is safer than only culprit vessel PCI, can reduce the incidence of MACE, improves the prognosis, and reduces hospitalization rates within the 12 months after PCI in acute STEMI patients with MVD.