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
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.