Prognostic factors of non-infarct-related arterial revascularization in STEMI patients with multivessel disease

Background Multivessel disease(MVD)is common in patients presenting with ST-segment elevation myocardial infarction(STEMI).But there is controversy over how to manage significant lesions in non-infarct-related artery(non-IRA).Methods A total of 221 patients diagnosed with STEMI and MVD who underwent percutaneous coronary intervention(PCI)at our cardiology department between January 2018 and June 2021 were included in this study.Among them,115 patients underwent complete revascularization within 30 days and were assigned to the complete revascularization group,while 106 patients who did not undergo complete revascularization within 30 days were assigned to the IRA-only revascularization group.Patients were followed up at 12 months.The primary endpoint event was adverse cardiovascular events(MACEs).Results There was no significant statistical difference in MACEs between the two groups of patients,but the incidence of heart failure in the IRA-Only group was significantly higher than that in the complete revascularization group.In the complete revascularization group,the number of stents,Killip class Ⅱ/Ⅲ on admission,and complete revascularization time were independent predictors of MACEs.Receiver operating characteristic curve(ROC)curve analysis showed that complete revascularization time had good predictive power for MACEs(Area under the curve:0.74695%CI:0.680-0.801),with a cut-off value of 10.3 days.Conclusions For STEMI patients with concurrent MVD,complete revascularization can reduce the incidence of heart failure.What's more,short-term staged(within 10 days)complete revascularization may further improve clinical outcomes.

Major risk-stratification models fail to predict outcomes in patients with multivessel coronary artery disease undergoing simultaneous hybrid procedure

Background The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting （CABG） and percutaneous coronary intervention （PCI） and is an alternative to revascularization treatment. We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events （MACCE） in patients with multivessel disease undergoing hybrid coronary revascularization. Methods The data of 120 patients were retrospectively collected and the SYNTAX score, EuroSCORE, SinoSCORE and the Global Risk Classification （GRC） calculated for each patient. The outcomes of interest were 2.7-year incidences of MACCE, including death, myocardial infarction, stroke, and any-vessel revascularization. Results During a mean of 2.7-year follow-up, actuarial survival was 99.17%, and no myocardial infarctions occurred. The discriminatory power （area under curve （AUC）） of the SYNTAX score, EuroSCORE, SinoSCORE and GRC for 2.7-year MACCE was 0.60 （95% confidence interval 0.42-0.77）, 0.65 （0.47-0.82）, 0.57 （0.39-0.75） and 0.65 （0.46-0.83）, respectively. The calibration characteristics of the SYNTAX score, EuroSCORE, SinoSCORE and GRC were 3.92 （P=0.86）, 5.39 （P=0.37）, 13.81 （P=0.32） and 0.02 （P=0.89）, respectively. Conclusions In patients with multivessel disease undergoing a hybrid procedure, the SYNTAX score, EuroSCORE, SinoSCORE and GRC were inaccurate in predicting MACCE. Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.

Contrast-induced nephropathy after staged percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease

Background Contrast-induced nephropathy（CIN） occurs frequently in patients undergoing primary percutaneous coronary intervention（PCI） for ST-segment elevation myocardial infarction（STEMI） and is associated with poor outcomes. Multivessel coronary artery disease（MVCAD） is considered to be a potentially important risk factor for CIN. There are still no data on CIN in patients undergoing staged PCI for STEMI and MVCAD. Therefore, we explored the incidence, risk factors, in-hospital and follow-up outcomes of CIN in this special population. Methods From 2011 to 2018, we enrolled 103 consecutive patients with STEMI who underwent staged PCI for MVCAD. CIN was defined as a relative increase of 〉 25% or an absolute increase of ≥ 0.5 mg/dL in SCr from the baseline value 72 h after exposure to the contrast medium. The incidence, risk factors, in-hospital and follow-up outcomes of CIN in this special population were studied. Results We found1） the incidence of CIN after primary PCI and staged PCI was 16.50% and 25.20%, respectively. 2） patients with CIN had worse in-hospital and follow-up outcomes. 3） in multivariate logistic analysis, independent risk factors for CIN included：（1） lower creatinine clearance at baseline;（2） atrioventricular block requiring temporary cardiac pacemaker implantation;（3） use of IABP at baseline;（4） total contrast volume administered（ primary PCI ＋staged PCI）;（5） shorter time interval between primary PCI and staged PCI. Conclusions CIN is a frequent complication in patients with STEMI and MVCAD undergoing staged PCI. The development of CIN is associated with worse in-hospital and follow-up outcomes.

Hybrid minimally invasive coronary artery revascularization

Background Hybrid coronary revascularization （HCR） is an altemative coronary revascularization strategy that combines a minimally invasive, survival advantage of the left internal mammary artery （LIMA） -left anterior descending （LAD） coronary artery bypass with less-invasive percutaneous coronary intervention （PCI） to non-LAD coronary lesions by using drug-eluting stents. We report our experience of hybrid minimally invasive approach in 15 patients. Methods From December 2012 to October 2013, 15 patients underwent revascularization of the left anterior descending artery through minimally invasive coronary artery bypass grafting （MIDCAB）. All patients by endoscopic assist beating heart coronary artery bypass grafting. Seven patients were scheduled for a hybrid procedure. Percutaneous coronary intervention of non- LAD was performed 3 to 5 days preoperatively. Demographic data, perioperative outcome, and annual follow-up were obtained from all the patients. Results In-hospital mortality was 6.67%. The rate of conversion to full median sternotomy was 13.3%. Ventilation time was 6.9 ± 5.1 h. Blood loss volume was 241 ± 67.8 mL. ICU stay was 21.3 ± 10.8 h. Hospital postoperative stay lasted for 7.5 ± 1.3 days. Prior to PCI patients showed 100% patent LIMA （Tables 3 and 4）. A mean follow-up was 8.5 months. One year graft patency rate was 100% （8/8 patients for 254-slice tomography）. Two patients required reintervention. Conclusions Minimally invasive hybrid coronary revascularization is a safe, feasible and efficacious approach with good results and should be performed in selected patients by surgeons with experience in minimally invasive bypass surgery plus collaboration with cardiologists, eluting stents.