Effect of the terms of complete revascularization on the outcomes of treatment of patients with ST segment elevation myocardial infarction and multivessel coronary artery disease

Tarasov R.S., Ganyukov V.I., Popov V.A., Shaposhnikov P.A., Barbarash O.L., Barbarash L.S.

Department of Multifocal Atherosclerosis, Scientific Research Institute for Complex Problems of Cardiovascular Diseases under the Siberian Branch of the Russian Academy of Medical Sciences, Kemerovo, Russia

The study was aimed at evaluating the results of treating a total of 227 patients presenting with ST segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent primary percutaneous interventions (PCI). The patients were subdivided into three groups: Group One consisted of the patients having endured multivessel stenting (MVS) within the framework of a primary PCI (n=40); Group Two comprised patients having endured stagewise revascularization (SWR) carried out within 60 days after the index event (mean 29.9±19.6 days) (n=39), and Group Three was composed of patients with stagewise revascularization either performed or planned to be performed within the terms exceeding 60 days (mean value 183.4±90.7 days) (n=148). During 12 months significant differences were observed between Group One and Group Three patients, as well as between Group Two and Group Three patients by the frequency of the composite end point (death, myocardial infarction, secondary revascularization of the target vessel (TVR) (p<0.05) and separately by the TVR between Group Two and Three patients (p<0.05). Besides, there was a tendency towards significant differences between Group One and Group Three patients, as well as Group Two and Group Three patients by the development of recurrent MI (p<0.05). By the number of lethal outcomes no statistically significant differences between the groups were observed. Hence, in the cohort of patients with STEMI and MVD who were subjected to primary PCIs, performing of MVS or secondary revascularization within 60 days has advantages as compared with the time period > 60 days by the frequency of the composite end point, TVR and is associated with a tendency towards lower incidence rate of recurrent MI during 12 months of follow up. The strategy of MVS and the secondary SoR within 60 days demonstrated comparable results during 12 months. Performing complete revascularization within the framework of primary PCI or shortly after discharge from the hospital (29.9±19.6 days) is associated with greater availability of the second SoR as compared with that planned for the terms of 183.4±90.7 days.

KEY WORDS: myocardial infarction, primary percutaneous coronary intervention, multivessel stenting, stagewise revascularization, multivessel disease.

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