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Complete Revascularization versus Culprit- Vessel Revascularization in Acute Myocardial Infarction: Six Months Follow-up

Walid Omar, Karim Mashhour, Ahmed Mowafy, Hatem El Atroush, Helmy El Ghawaby

Background: The presence of multi-vessel disease (MVD) has been reported to be associated with worse prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Identification of optimal strategies for treating such patients is the subject of considerable interest and controversy.

Objective: The aim of our study is to compare the in-hospital and short-term prognosis for patients presenting with STEMI who were treated by two different modalities. The treatment varied between target vessel revascularization (TVR) and complete revascularization (CR) in patients with MVD undergoing primary percutaneous coronary intervention (p-PCI).

Methods: A total of 40 patients with recent STEMI and MVD undergoing p-PCI were randomized to CR (group A) or TVR (group B) during p-PCI and followed up for 6 months after hospital discharge. The patients were followed-up for incidence of major adverse cardiac events (MACE) (in-hospital, and at 1 and 6 months after discharge), contrast-induced nephropathy (CIN) and left ventricular ejection fraction (LVEF) improvement at 6 months.

Results: Forty patients (mean age 55.2 ± 9.1 years; 33 males and 7 females) with comparable risk factors in the two groups were recruited in this study. Six months later, the patients in group A showed better improvement in systolic function as estimated by 2D echocardiography LVEF % (54.3 ± 9.1 to 58.4 ± 6.2; P-value 0.002) compared to group B (54.9 ± 5.2 to 55.7 ± 6.7; P-value 0.55). This improvement was more in patients with anterior wall myocardial infarctions. The incidence of MACE in both groups was comparable during the hospital stay and at 1 and 6 months follow-up. There were two MACE cases in group B, and no such case was observed in group A at 1 and 6 months follow-up (P-value 0.14). With regard to CIN, both groups showed similar results (2 cases in group A and 1 case in group B; P-value 0.54). The patients with door-to-balloon time less than 90 minutes were associated with better LVEF in comparison to those with a door-to-balloon time of more than 90 minutes (57.1 ± 6.3 vs. 50.5 ± 7.3; P-value 0.005).

Conclusion: The results of our study showed that CR is safe during p-PCI and is associated with better left ventricular EF at 6 months, especially in anterior myocardial infarction.