Prognosis of culprit lesion PTCA in acute myocardial infarction for multi versus single vessel disease

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Abstract
We studied 417 patients undergoing single vessel culprit lesion percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction to determine the impact of disease in other vessels. Group A (189 patients, 45%) had coronary artery disease (>70% stenosis) in at least 1 additional vessel while Group B (228 patients, 55%) did not. The groups were similar in sex distribution (A = 75% male, B = 76%), number of lesions in the single culprit vessel dilated (1 lesion in 83% A, 80% B), and PTCA success (A = 92%, B = 94%) (all p = NS). Group A patients were older (63 ± 10 vs. 56 ± 11 years) and had more prior myocardial infarctions (27% vs. 7%), and more prior coronary artery bypass grafting (15% vs. 0.4%) (all p < .01). Group A patients were more likely to have repeat catheterization (48% vs. 32%, p < .005) although restenosis of the infarct‐related vessel was similar (A = 24%, B = 16%) (p = NS). Group A was more likely to need angioplasty in a 2nd vessel (23% vs. 8%) and to need coronary artery bypass grafting (20% vs. 8%) (both p < .001). Cumulative mortality was higher in Group A at 1 month (10% vs. 5%), 1 year (11% vs. 6%), and long‐term (13% vs. 7%). This difference appeared to be due to the impact of lower mean ejection fraction in Group A.Conclusion: Treatment of acute myocardial infarction by direct PTCA of the culprit lesion can be performed with a high likelihood of success in patients with or without multivessel coronary artery disease. Patients with multivessel disease are identified as a high risk group for whom subsequent interventional therapy may be required after the acute event. Mortality, however, is affected more by left ventricular function than by the presence of multivessel disease.

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