[Complete revascularisation of multivessel coronary artery disease during acute myocardial infarction. Results following hospitalization and after 30 months. Series of 86 interventions carried out with 167 multivessel disease patients; causes of failure]

Abstract

This series studied 167 patients with multivessel disease, admitted consecutively for acute myocardial infarction (excluding cardiogenic shock), who underwent systematic angioplasty and stenting before the 12th hour of the culprit artery and the other vessels with >70% (QCA) angiographic stenosis, and followed up for a period of 8 to 68 months with an average follow-up of 2.5 years. The criteria of evaluation were: numbers of asymptomatic patients, deaths, new infarctions, residual ischaemias, cardiac failure, angioplasties or bypass surgeries. On admission, 43.1% of infarcts were anterior, 48.5% inferior or postero-inferior and 8.3% lateral wall infarcts. One hundred and twenty-two consecutive patients had double vessel disease and 45 has triple vessel disease. The failures of revascularisation of the culprit artery were excluded from the study. The feasibility rate of complete multivessel revascularisation in a single procedure was over half the cases (86 out of 167, 51.5%): 60.6% of double vessel disease and 26.9% of triple vessel disease, a simple favorable anatomical presentation being necessary to accomplish this objective. During the hospital period (30 days), 95.3% of patients who were completely revascularised remained totally asymptomatic, 2 (2.3%) had recurrent infarction, 1 (1%) had cardiac failure and 1 (1%) died of a non-cardiac cause. No cardiac deaths were observed in this series. Of the multivessel disease patients who could not be completely revascularised (N=81) (poor clinical state or complicated anatomical presentation), 83.6% were asymptomatic: there were 7.7% cases of cardiac failure, 2.4% of recurrent infarction; 1.2% died of non-cardiac causes and 1.2% died of a cardiac cause. The statistical difference was significant in favour of the patients who had successful complete revascularisation with respect to the others in terms of numbers of asymptomatic patients (p=0.004) and of numbers of cardiac failure (p=0.002). The follow-up rate of patients who had complete revascularisation in a single procedure was 98.8%. After two and a half years of follow-up, 74.1% of patients were totally asymptomatic; the cumulative major cardiac adverse event rate (death, infarction, angioplasty or bypass surgery) was 29.4% and the reoperation rate by angioplasty or bypass surgery was 27%.