World Journal of Emergency Medicine ›› 2025, Vol. 16 ›› Issue (4): 367-373.doi: 10.5847/wjem.j.1920-8642.2025.070
• Research Letters • Previous Articles Next Articles
Yugen Shi1, Nannan Li2, Xue Feng3, Qingshan Zhang3, Shuai Bao3, Zheng Zhao3, Li Sun3, Suhua Yan1, Ye Wang1(
), Xiaolu Li3()
Received:2024-07-06
Accepted:2024-12-13
Online:2025-07-18
Published:2025-07-01
Contact:
Ye Wang,Xiaolu Li
E-mail:yeziwang812@163.com;lixiaolu007@hotmail.com
Yugen Shi, Nannan Li, Xue Feng, Qingshan Zhang, Shuai Bao, Zheng Zhao, Li Sun, Suhua Yan, Ye Wang, Xiaolu Li. Clinical outcomes of patients with acute myocardial infarction undergoing coronary revascularization via simplified treatment: a single-center retrospective study[J]. World Journal of Emergency Medicine, 2025, 16(4): 367-373.
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URL: http://wjem.com.cn/EN/10.5847/wjem.j.1920-8642.2025.070
Figure 1.
Flowchart of the inclusion process for study participants. AMI: acute myocardial infarction; CAG: coronary angiography; CABG: coronary artery bypass grafting.
Table 1.
Baseline characteristics of the AMI patients (n=159)
| Characteristics | Data |
|---|---|
| Age, years, mean±SD | 65.7±12.6 |
| Male, n (%) | 116 (73.0) |
| Smoker, n (%) | 80 (50.3) |
| Hypertension, n (%) | 82 (51.6) |
| Diabetes, n (%) | 49 (30.8) |
| Previous MI, n (%) | 13 (8.2) |
| Previous PCI, n (%) | 13 (8.2) |
| Previous CABG, n (%) | 0 (0) |
| Previous stroke, n (%) | 16 (10.0) |
| Previous autoimmune disease, n(%) | 2 (1.3) |
| LV ejection fraction, %, mean±SD | 52.6±9.0 |
| Hemoglobin, g/L, mean±SD | 134.8±19.7 |
| Glycosylated hemoglobin, %, mean±SD Total cholesterol, mmol/L, mean±SD | 7.7±1.5 4.2±1.0 |
| HDL, mmol/L, mean±SD | 1.0±0.3 |
| LDL, mmol/L, mean±SD | 2.5±0.8 |
| Creatinine, μmol/L, mean±SD | 72.0±20.5 |
| eGFR, mL/min, mean±SD | 90.0±23.8 |
| Clinical presentation, n (%) | |
| STEMI | 135 (84.9) |
| NSTEMI | 24 (15.1) |
| Peak troponin I, ng/mL, mean±SD | 40.9±20.4 |
| Killip classification, n (%) | |
| I | 123 (77.4) |
| II | 19 (11.9) |
| III | 17 (10.7) |
| Medication during hospitalization, n (%) | |
| Aspirin | 151 (95.0) |
| Ticagrelor | 110 (69.2) |
| Clopidogrel | 49 (30.8) |
| ACE inhibitor | 101 (63.5) |
| ARB | 9 (5.7) |
| Calcium-channel blocker | 10 (6.13) |
| Nitrates | 140 (88.1) |
| Statin | 152 (95.6) |
Table 2.
Procedural and lesion characteristics of the AMI patients (n=159)
| Characteristics | Data, n (%) |
|---|---|
| Radial access | 148 (93.1) |
| Vessels with disease | |
| 1 | 30 (18.9) |
| 2 | 36 (22.6) |
| 3 | 93 (58.5) |
| Culprit vessel | |
| LM | 1 (0.6) |
| LAD | 75 (47.2) |
| LCX | 21 (13.2) |
| RCA | 62 (39.0) |
| Characteristics of culprit vessel lesions | |
| General lesion | 57 (35.8) |
| Bifurcation lesion | 7 (4.4) |
| Long lesion | 82 (51.6) |
| Calcified lesion | 14 (8.8) |
| Twisted lesion | 1 (0.6) |
| High thrombosis | 17 (10.7) |
| Lesion treatment | |
| PTCA | 149 (93.8) |
| Drug-coated balloon | 108 (67.9) |
| Cutting balloon | 22 (20.3) |
| Scoring balloon | 12 (11.1) |
| Plain balloon | 41 (25.8) |
| Intravascular thrombolysis | 5 (3.1) |
| Thrombus suction | 5 (3.1) |
| Residual stenosis of culprit vessel | |
| >60% | 21 (13.2) |
| 30%-60% | 34 (21.4) |
| <30% | 104 (65.4) |
| Coronary dissection severity (NHLBI) | |
| Type A | 31 (19.4) |
| Type B | 12 (7.5) |
| TIMI before intervention | |
| 0 | 138 (86.8) |
| I | 3 (1.9) |
| II | 7 (4.4) |
| III | 11 (6.9) |
| TIMI post intervention | |
| 0 | 1 (0.6) |
| I | 1 (0.6) |
| II | 20 (12.6) |
| III | 137 (86.2) |
Table 3.
Study endpoints (n=159)
| Endpoints | Results, n (%) |
|---|---|
| MACEs | 11 (6.9) |
| CV death | 4 (2.5) |
| Non-fatal AMI | 5 (3.1) |
| TVR | 2 (1.3) |
| Stroke | 0 (0) |
| Secondary endpoint | 17 (10.7) |
| Hospital admission for heart failure | 2 (1.3) |
| Hospital admission for UAP | 16 (10.1) |
Table 4.
Subgroup analysis of different treatments
| Events | Coronary intervention | Residual stenosis of culprit vessel | |||||||
|---|---|---|---|---|---|---|---|---|---|
| PTCA | Intravascular thrombolysis (n=5) | Thrombus suction (n=5) | ≥60% (n=21) | <60% (n=138) | P-value | ||||
| DCB (n=108) | Plain balloon (n=41) | P-value | |||||||
| MACE | 6 | 3 | 0.687 | 1 | 1 | 2 | 9 | 0.614 | |
| CV death | 1 | 1 | 1 | 1 | 1 | 3 | |||
| Non-fatal AMI | 4 | 1 | 0 | 0 | 1 | 4 | |||
| TVR | 1 | 1 | 0 | 0 | 0 | 2 | |||
| Second endpoint | 8 | 9 | 0.013 | 0 | 1 | 2 | 16 | 0.780 | |
| Hospital admission for HF | 1 | 1 | 0 | 0 | 0 | 2 | |||
| Hospital admission for UAP | 7 | 8 | 0 | 1 | 2 | 14 | |||
| 1 | Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020; 141(9): e139-e596. |
| 2 | Wang ZW, Ma LY, Liu MB, Fan J, Hu SS; Writing Committee of the Report on Cardiovascular Health and Diseases in China. Summary of the 2022 report on cardiovascular health and diseases in China. Chin Med J (Engl). 2023; 136(24): 2899-908. |
| 3 | Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. FRagmin and Fast Revascularisation during InStability in Coronary artery disease Investigators. Lancet. 1999; 354(9180): 708-15. |
| 4 |
Bhatt DL, Roe MT, Peterson ED, Li Y, Chen AY, Harrington RA, et al. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA. 2004; 292(17): 2096-104.
doi: 10.1001/jama.292.17.2096 pmid: 15523070 |
| 5 |
Fox KA, Clayton TC, Damman P, Pocock SJ, de Winter RJ, Tijssen JG, et al. Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. J Am Coll Cardiol. 2010; 55(22): 2435-45.
doi: 10.1016/j.jacc.2010.03.007 pmid: 20359842 |
| 6 |
Fox KA, Poole-Wilson PA, Henderson RA, Clayton TC, Chamberlain DA, Shaw TR, et al. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial. Randomized Intervention Trial of unstable Angina. Lancet. 2002; 360(9335): 743-51.
doi: 10.1016/s0140-6736(02)09894-x pmid: 12241831 |
| 7 |
Foo CY, Bonsu KO, Nallamothu BK, Reid CM, Dhippayom T, Reidpath DD, et al. Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis. Heart. 2018; 104(16): 1362-9.
doi: 10.1136/heartjnl-2017-312517 pmid: 29437704 |
| 8 | Saito Y, Oyama K, Tsujita K, Yasuda S, Kobayashi Y. Treatment strategies of acute myocardial infarction: updates on revascularization, pharmacological therapy, and beyond. J Cardiol. 2023; 81(2): 168-78. |
| 9 |
Kirtane AJ, Gupta A, Iyengar S, Moses JW, Leon MB, Applegate R, et al. Safety and efficacy of drug-eluting and bare metal stents: comprehensive meta-analysis of randomized trials and observational studies. Circulation. 2009; 119(25): 3198-206.
doi: 10.1161/CIRCULATIONAHA.108.826479 pmid: 19528338 |
| 10 |
Mehta SR, Cannon CP, Fox KA, Wallentin L, Boden WE, Spacek R, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005; 293(23): 2908-17.
doi: 10.1001/jama.293.23.2908 pmid: 15956636 |
| 11 |
Group ITR, Maron DJ, Hochman JS, O’Brien SM, Reynolds HR, Boden WE, et al. International study of comparative health effectiveness with medical and invasive approaches (ISCHEMIA) trial: rationale and design. Am Heart J. 2018; 201: 124-35.
doi: S0002-8703(18)30122-4 pmid: 29778671 |
| 12 | Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007; 356(15): 1503-16. |
| 13 | Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, et al. Drug-coated balloons for coronary artery disease: third report of the international DCB consensus group. EuroIntervention. 2020; 13(12): 1391-402. |
| 14 |
Scheller B, Ohlow MA, Ewen S, Kische S, Rudolph TK, Clever YP, et al. Bare metal or drug-eluting stent versus drug-coated balloon in non-ST-elevation myocardial infarction: the randomised PEPCAD NSTEMI trial. EuroIntervention. 2020; 15(17): 1527-33.
doi: EIJ-D-19-00723 pmid: 31659986 |
| 15 | Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018; 138(20): e618-e651. |
| 16 | Yang YX, He KZ, Li JY, Fu Y, Li C, Liu XM, et al. Comparisons of drug-eluting balloon versus drug-eluting stent in the treatment of young patients with acute myocardial infarction. J Cardiovasc Dev Dis. 2023; 10(1): 29. |
| 17 | Hayward CJ, Batty JA, Westhead DR, Johnson O, Gale CP, Wu JH, et al. Disease trajectories following myocardial infarction: insights from process mining of 145 million hospitalisation episodes. EBioMedicine. 2023; 96: 104792. |
| 18 | Zhang F, Su S, Hou Y, Zhao L, Wang Z, Liu F, et al. Effects (MACE and bleeding events) of ticagrelor combined with omeprazole on patients with acute myocardial infarction undergoing primary PCI. Hellenic J Cardiol. 2020; 61(5): 306-10. |
| 19 | Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Shin DH, et al. Clinical outcomes at 2 years between beta-blockade with ACE inhibitors or ARBs in patients with AMI who underwent successful PCI with DES: a retrospective analysis of 23, 978 patients in the Korea AMI registry. Am J Cardiovasc Drugs. 2019; 19(4): 403-14. |
| 20 | Ge Z, Baber U, Claessen BE, Farhan S, Chandrasekhar J, Li SX, et al. The prevalence, predictors and outcomes of guideline-directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry. Catheter Cardiovasc Interv. 2019; 93(3): E112-E119. |
| 21 | Vergallo R, Crea F. Atherosclerotic plaque healing. N Engl J Med. 2020; 383(9): 846-57. |
| 22 | Wang Z, Ye D, Ye J, Wang ML, Liu JF, Jiang HM, et al. ADAMTS-5 decreases in coronary arteries and plasma from patients with coronary artery disease. Dis Markers. 2019; 2019: 6129748. |
| 23 | Olbrich H, Kridin K, Zirpel H, Sadik CD, Terheyden P, Thaçi D, et al. Cutaneous lupus erythematosus is associated with an increased risk of cardiac and vascular diseases: a large-scale, propensity-matched global retrospective cohort study. EBioMedicine. 2023; 93: 104639. |
| 24 |
Arbab-Zadeh A, Fuster V. From detecting the vulnerable plaque to managing the vulnerable patient: JACC state-of-the-art review. J Am Coll Cardiol. 2019; 74(12): 1582-93.
doi: S0735-1097(19)36162-5 pmid: 31537269 |
| 25 | Zhuang LF, Zong X, Yang Q, Fan Q, Tao R. Interleukin-34-NF-κB signaling aggravates myocardial ischemic/reperfusion injury by facilitating macrophage recruitment and polarization. EBioMedicine. 2023; 95: 104744. |
| 26 | Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999; 341(9): 625-34. |
| 27 |
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119-77.
doi: 10.1093/eurheartj/ehx393 pmid: 28886621 |
| 28 |
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. J Am Coll Cardiol. 2016; 67(10): 1235-50.
doi: S0735-1097(15)06797-2 pmid: 26498666 |
| 29 |
Ozaki Y, Katagiri Y, Onuma Y, Amano T, Muramatsu T, Kozuma K, et al. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018. Cardiovasc Interv Ther. 2018; 33(2): 178-203.
doi: 10.1007/s12928-018-0516-y pmid: 29594964 |
| 30 | Guan C, Yang C, Song L, Chen J, Qian J, Wu F, et al. Association of acute procedural results with long-term outcomes after CTO PCI. JACC Cardiovasc Interv. 2021; 14(3): 278-88. |
| 31 | McFadden EP, Stabile E, Stabile E, Regar E, Cheneau E, Ong AT, et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet. 2004; 364(9444): 1519-21. |
| 32 | Ma J, Liu XL, Qiao L, Meng LL, Xu XL, Xue F, et al. Association between stent implantation and progression of nontarget lesions in a rabbit model of atherosclerosis. Circ Cardiovasc Interv. 2021; 14(11): e010764. |
| 33 |
Mintz GS. Remodeling and restenosis: observations from serial intravascular ultrasound studies. Curr Interv Cardiol Rep. 2000; 2(4): 316-25.
pmid: 11096682 |
| 34 | Saito S, Hosokawa G, Tanaka S, Nakamura S. Primary stent implantation is superior to balloon angioplasty in acute myocardial infarction: final results of the primary angioplasty versus stent implantation in acute myocardial infarction (PASTA) trial. PASTA Trial Investigators. Catheter Cardiovasc Interv. 1999; 48(3): 262-8. |
| 35 |
Tsuchihashi M, Tsutsui H, Shihara M, Tada H, Kono S, Takeshita A, et al. Comparison of outcomes for patients undergoing balloon angioplasty vs coronary stenting for acute myocardial infarction. Circ J. 2003; 67(5): 369-74.
pmid: 12736471 |
| 36 | Vos NS, Fagel ND, Amoroso G, Herrman JR, Patterson MS, Piers LH, et al. Paclitaxel-coated balloon angioplasty versus drug-eluting stent in acute myocardial infarction: the REVELATION randomized trial. JACC Cardiovasc Interv. 2019; 12(17): 1691-9. |
| 37 | Gao JQ, Zhang X, Xu MZ, Deng SS, Chen XP. The efficacy and safety of sacubitril/valsartan compared with ACEI/ARB in the treatment of heart failure following acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Front Pharmacol. 2023; 14: 1237210. |
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