Strategy for non -infarction related artery post primary percutaneous coronary intervention in acute myocardial infarction

doi:10.3969/j.issn.1002-1949.2014.09.011

Abstract：Objective To evaluate short -term percutaneous coronary intervention (PCI) for non-infarction related artery ( IRA) compared with ischemia related PCI accompanied with optimized medical therapy in acute myocardial infarction ( AMI) and multivessel disease .Methods From January 2009 to June 2011 , a total of 302 patients with AMI and mutivessel disease were enrolled in this retrospective study .These patients underwent primary PCI and were randomly assigned to group A ( staged PCI for non-IRA within 7~10 days after AMI ) and group B ( no staged PCI group ) .In group B, subsequent PCI for non -IRA was recommended only for ischemia evidence .Optimized medical therapy was administrated for all of patients according to clinical guideline .The primary outcome was recurrence of myocardial infarction , target vessel revascularization ( TVR) and death from cardiac causes in 24 months follow -up.The secondary outcomes were PCI for ischemia , heart failure, angina and rehospitalization from cardiac causes .Results After 24 months follow-up visit, 288 patients finished the experiment in group A (145 patients) and group B (143 patients).The primary outcome occurred in 12 patients in group A and in 15 patients in group B (P=0.519).There was no patient dead in the PCI operation for non-IRA in two groups .But the secondary outcomes were obviously higher in group B than those in group A , inclusive revascularization , heart failure , refractory angina and rehospitalization . Conclusion In patients with AMI and multivessel coronary artery disease undergoing primary PCI , staged PCI within 7~10 days for non-IRA is safe and decrease the risk of revascularization , angina and rehospitalization .But staged PCI dose not reduce the risk of death from cardiac causes , myocardial infarction and heart failure .