Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland.
Student Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland.
Int J Environ Res Public Health. 2022 Oct 13;19(20):13160. doi: 10.3390/ijerph192013160.
Revascularisation strategy in patients with multi-vessel coronary disease and acute myocardial infarction (AMI) remains challenging. One of the potential treatment options is complete percutaneous revascularisation during index hospitalisation. This strategy could positively influence left ventricle ejection fraction (LVEF).
To investigate the long-term changes in LVEF and clinical outcome among patients with AMI after complete coronary revascularisation (CCR).
Records of 171 patients with a diagnosis of AMI and multi-vessel coronary artery disease (CAD) on index angiography, in whom CCR was performed as a staged procedure during initial hospitalisation, were analysed. Clinical data were collected from in-hospital medical records and discharge letters. Cardiac ultrasound (CU), with particular assessment of LVEF, was performed one day before discharge. Follow-up (FU) CU was collected from the out-patient department at least six months ± one week after discharge. Follow-up data, including major adverse cardiac events (MACE), were collected during follow-up visits by telephone. Depending on the LVEF change during the follow-up period, patients were divided into two groups. Patients with a decrease in the LVEF (D-LVEF group) were compared with patients with no changes (preserved) or improvement regarding LVEF (P/I-LVEF).
The median duration of the follow-up was 19 months (14-24 months). The median change in LVEF during observation was -5.0p% (IQR (-7.0)-(-2.75p.%)) in the D-LVEF group and +4.0% (IQR 1.0-5.0p%) in the P/I-LVEF group. Among patients in the P/I-LVEF group, there was a sub-group of patients with no change in LVEF (28 patients), and one demonstrating improvement in LVEF (104 patients). In the subgroup of patients with improved LVEF, the median change in LVEF was 4.5p% (IQR 2-6.25p%). Among patients with decreasing LVEF, there was a significantly higher risk of MACE (15 vs. 2.3%, = 0.031), especially non-fatal AMI (10 vs. 0%, = 0.017). We found the following among predictors concerning increased risk of MACE occurrence: urgent PCI ( = 0.004), hospitalisations regardless of cause ( = 0.028), EF worsening ( = 0.025), fasting glucose serum concentration ( = 0.024) and fasting triglyceride serum concentration ( = 0.027).
Complete revascularisation (CR) at baseline (one stage) in patients with AMI and multi-vessel disease is associated with LVEF improvement and MACE rate reduction. Patients with worse LVEF have poor clinical outcome and a higher rate of MACE.
多支血管病变合并急性心肌梗死（AMI）患者的血运重建策略仍然具有挑战性。潜在的治疗选择之一是在指数住院期间进行完全经皮血运重建。该策略可能会对左心室射血分数（LVEF）产生积极影响。
研究完全冠状动脉血运重建（CCR）后 AMI 患者 LVEF 的长期变化和临床结局。
分析了 171 例 AMI 合并多支血管病变（CAD）患者的指数血管造影记录，在初次住院期间进行了分期 CCR。临床数据来自住院病历和出院信。在出院前一天进行心脏超声（CU）检查，特别是评估 LVEF。在出院后至少 6 个月±1 周时，从门诊部收集随访 CU。通过电话在随访期间收集随访数据，包括主要不良心脏事件（MACE）。根据随访期间 LVEF 的变化，将患者分为两组。LVEF 下降（D-LVEF 组）的患者与 LVEF 无变化（保留）或改善（P/I-LVEF 组）的患者进行比较。
中位随访时间为 19 个月（14-24 个月）。D-LVEF 组在观察期间 LVEF 的中位变化为-5.0p%（IQR（-7.0）-（-2.75p.%）），P/I-LVEF 组为+4.0%（IQR 1.0-5.0p%）。在 P/I-LVEF 组中，有一个 LVEF 无变化的亚组（28 例），一个 LVEF 改善的亚组（104 例）。在 LVEF 改善的亚组中，LVEF 的中位变化为 4.5p%（IQR 2-6.25p%）。在 LVEF 下降的患者中，MACE 的风险显著增加（15% vs. 2.3%，=0.031），尤其是非致命性 AMI（10% vs. 0%，=0.017）。我们发现以下因素与 MACE 发生的风险增加有关：紧急 PCI（=0.004）、无论原因如何的住院治疗（=0.028）、EF 恶化（=0.025）、空腹血糖血清浓度（=0.024）和空腹甘油三酯血清浓度（=0.027）。
AMI 合并多支血管病变患者的基线（一期）完全血运重建与 LVEF 改善和 MACE 发生率降低相关。EF 较差的患者临床结局较差，MACE 发生率较高。
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