Flow worsening during primary percutaneous coronary intervention was significantly associated with an increased risk of major adverse cardiac events (HR 3.24) in STEMI patients despite achieving a door-to-balloon time <90 minutes.
Cohort (n=383)
No
Even when door-to-balloon time is <90 minutes, STEMI patients remain at risk for MACE due to factors like low BMI, high Killip class, prior MI, and procedural flow worsening, highlighting the need for additional therapeutic targets beyond rapid reperfusion.
Hazard Ratio: 3.24 (95% CI 1.79–5.86)
p-value: p=<0.001
BACKGROUND: Recent guidelines for ST-elevation myocardial infarction (STEMI) recommended the door-to-balloon time (DTBT) 20 kg/m2: HR 2.80, 95% CI 1.39-5.64, p = 0.004), history of previous myocardial infarction (HR 2.39, 95% CI 1.06-5.37, p = 0.04), and Killip class 3 or 4 (vs. Killip class 1 or 2: HR 2.39, 95% CI 1.30-4.40, p = 0.005) were significantly associated with MACE. In another multivariate Cox hazard model, flow worsening during percutaneous coronary intervention (PCI) (HR 3.24, 95% CI 1.79-5.86, p<0.001) and use of mechanical support (HR 3.15, 95% CI 1.71-5.79, p<0.001) were significantly associated with MACE, whereas radial approach (HR 0.54, 95% CI 0.32-0.92, p = 0.02) was inversely associated with MACE. CONCLUSION: Low body mass index, Killip class 3/4, history of previous myocardial infarction, use of mechanical support, and flow worsening were significantly associated with MACE, whereas radial-access was inversely associated with MACE. It is important to avoid flow worsening during primary PCI even when appropriate DTBT was achieved.
Tsukui et al. (Thu,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=383). Flow worsening during PCI vs. No flow worsening was evaluated on Major adverse cardiac events (MACE) defined as the composite of all-cause death, acute myocardial infarction, and acute heart failure requiring hospitalization (HR 3.24, 95% CI 1.79-5.86, p=<0.001). Flow worsening during primary percutaneous coronary intervention was significantly associated with an increased risk of major adverse cardiac events (HR 3.24) in STEMI patients despite achieving a door-to-balloon time <90 minutes.