Poor clinical outcome despite successful recanalisation in patients with acute myocardial infarction undergoing direct percutaneous coronary intervention: a retrospective cohort study

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) remains a major cause of morbidity and mortality. Primary percutaneous coronary intervention (PPCI) is the preferred treatment, yet some patients experience major adverse cardiac events (MACE) within a year despite successful recanalisation. Identifying predictors of futile recanalisation-defined as achieving thrombolysis in myocardial infarction grade III flow after PPCI but still developing MACE-is essential for improving outcomes. RESEARCH DESIGN AND METHODS: This single-centre, retrospective study included patients with STEMI treated with PPCI from January 2019 to January 2023. The primary outcome was futile recanalisation. Least absolute shrinkage and selection operator (LASSO) regression and logistic regression were used to identify independent predictors of futile recanalisation. RESULTS: Of the 489 consecutive patients who achieved successful recanalisation, 20.9% met the criteria for futile recanalisation within 1 year. Multivariable analysis identified several independent predictors: heart rate at admission (OR 1.32, 95% CI 1.02 to 1.71), reduced left ventricular ejection fraction (LVEF; OR 0.30, 95% CI 0.22 to 0.41), advanced left ventricular diastolic dysfunction (OR 1.44, 95% CI 1.02 to 2.15), elevated cardiac troponin I (CTnI) levels (OR 1.42, 95% CI 1.08 to 1.90), high Selvester QRS scores (OR 1.59, 95% CI 1.20 to 2.13) and increased homocysteine (HCY) levels (OR 1.37, 95% CI 1.07 to 1.77). CONCLUSION: Despite successful recanalisation, certain factors-high admission heart rate, low LVEF, advanced left ventricular diastolic dysfunction, elevated CTnI levels, high Selvester QRS scores, and increased HCY levels-are associated with futile recanalisation in patients with STEMI. These findings highlight the need for targeted monitoring and management strategies to reduce long-term MACE risks in this population.