心筋梗塞急性期での冠動脈インターベンションによる多枝血行再建の有用性

Abstract

Purpose : Clinical outcome of multivessel coronary intervention in the acute phase of myocardial infarction was investigated. Subjects and methods : Among 73 consecutive patients with acute myocardial infarc- tion (AMI) who had multivessel disease and received successful direct percutaneous transluminal coronary angioplasty (PTCA) for infarct-related vessel, 15 patients (group A) received successful PTCA for non infarct-related vessel within 1 week after onset of AMI, and 53 patients (group B) did not within 4 weeks. Clinical characteristics, complica- tions after the intervention, and in-hospital prognosis were compared between the two groups. Results : The incidence of left ventricular ejection fraction lower than 40 % was significantly greater in group A than in group B (p<0.05). The incidence of elective coronary artery bypass grafting (CABG) was greater in group B than in group A (p<0.05). Abrupt closure after direct PTCA was seen in 1 patient in group B, and that after the intervention for non infarct-related vessel was seen in 1 patient. No patient in group A had CABG and died during the hospitalization, whereas 3 patients died in group B. Conclusions : In-hospital prognosis of patients who had successful multivessel inter- vention was excellent. Multivessel intervention in the acute phase may be performed safely and may improve prognosis of patients with multivessel disease, especially complicating severe left ventricular dysfunction.