ObjectiveCompare the therapeutic effects of multivessel percutaneous coronary intervention (MV-PCI) and culprit-only revascularization strategy (C-PCI) in percutaneous coronary intervention (PCI) for patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) and multivessel disease (MVD). MethodsThe PubMed, Embase, Cochrane Library, MEDLINE, Web of Science, CENTRAL, CNKI and WanFang Data databases were searched to collect studies comparing C-PCI vs. MV-PCI in patients with AMI and CS from inception to March 2, 2025. Methodological quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS) and the risk of bias (ROB) tool. Meta-analysis was performed using RevMan software (version 5.4.0). ResultsA total of 18 studies (1 randomized controlled trial, 1 post-hoc analysis of a randomized controlled trial, and 16 retrospective observational studies), enrolling 101 693 patients. The results of the observational studies showed that MV-PCI was associated with higher risk of short-term mortality (OR=1.13, 95%CI 1.01 to 1.25, P=0.03), renal replacement therapy (OR=1.41, 95%CI 1.32 to 1.50, P<0.00001), and cerebrovascular accident events (OR=1.21, 95%CI 1.10 to 1.33, P=0.0001). No significant difference was observed in long-term mortality (OR=0.93, 95%CI 0.74 to 1.16, P=0.51), recurrent myocardial infarction (OR=1.16, 95%CI 0.97 to 1.39, P=0.10), repeat revascularization events (OR=0.83, 95%CI 0.58 to 1.20, P=0.33) and bleeding event rates (OR=1.01, 95%CI 0.71 to 1.34, P=0.97) between groups. The results remained consistent after adding the only randomized trial.ConclusionsIn patients with AMICS and concomitant MVD, C-PCI provides comparable survival benefits to MV-PCI and is associated with a reduced risk of all-cause mortality, cerebrovascular events, and the need for renal replacement therapy.
ObjectiveTo summarize the experience of 4 patients with a great saphenous venous graft patency after 15 years of postoperitive great saphenous venous sequential aortic coronary artery bypass grafting.
MethodWe retrospectively analyzed the clinical data of 4 patients accepted great saphenous vein aortic coronary artery bypass graft under moderate hypothermia cardiopulmonary bypass from November 1989 to December 1992 year. There were 3 males and 1 female with a mean age of 48.3 years ranging from 40-58 years. We harvested great saphenous vein under groin 45-50 cm. The proximal and distal anastomoses were performed with parachute technique under two clamps technique. Coronary artery bypass graft was performed by two sequential grafts routinely. Aspirin was given through nasal tube 6 hours after operation. The risk factors of arteriosclerosis were controlled by patients themselves after discharge.
ResultFour patients received coronary angiography in 15, 16, 18, and 21 years after surgery and the grafts and both proximal and distal anastomoses were patent. The patients lived about 20 years without angina.
Conclusioncarefully dealing with the vein graft, taking sequential bypass grafting to guarantee parabolic curve and meticulous anastomosis are preconditional and necessary for long-term patency.
