Multivessel coronary artery disease: A key predictor of short-term prognosis after reperfusion therapy for acute myocardial infarction

摘要: Results of recent studies have suggested that routine cardiac catheterization may be unnecessary after reperfusion therapy for acute myocardial infarction. Therefore to better define the short-term prognostic value early coronary angiography, and specifically significance multivessel artery disease, angiographic findings 855 patients consecutively enrolled in five phases TAMI study were correlated with their in-hospital outcome. All received intravenous thrombolytic (tissue plasminogen activator, urokinase, or both agents) underwent within 90 minutes initiation therapy. Multivessel defined as presence 2 75% luminal diameter stenosis two more major epicardial arteries, was documented 238 patients. When compared group without this had a higher prevalence risk factors frequently history antecedent ischemic chest pain. Although severity infarct zone dysfunction similar groups (-2.77 + 1.00 vs -2.50 f 1.09 SD/chord, p = NS), global left ventricular ejection fraction lower disease (48.8 12.4% 51.8 10.6%, < 0.01). This associated wlth significant difference function noninfarct zone. Whereas region hyperkinetic minimal single-vessel it hypocontractile dyskinetic those (+0.66 L 1.53 -0.52 _+ 1.73 0.0001). The mortality rate, predominantly result failure cardiogenic shock, also significantly (11.4% 4.2%, By means data from 708 first three studies, statistical model developed describe determinants survival. logistic regression analysis strongest independent predictor number diseased vessels (p 0.002). Other parameters contributed included O.Ol), TIMI grade vessel flow 0.03), patient age 0.03). According one additional year equivalent reduction 1.1 percentage points; 15 years 16 points. These suggest aggressive revasculariration procedures should considered postinfarction period dysfunction. In absence reliable noninvasive techniques, angiography remains procedure choice identifying high-risk subgroup. (AM HEART J lQ91;121:1042.)