Key result
Heavy thrombus burden linked to ~78% higher risk of suboptimal coronary flow after STEMI PCI.
Why the study?
Suboptimal coronary blood flow following first PCI in STEMI patients is a multivariate phenomenon with several causes, but recognized modifiable risk factors and effective management plans are lacking.
Cohort (n=486)
No
Suboptimal coronary flow after primary PCI in STEMI occurs in nearly a quarter of patients and is associated with significantly higher 30-day MACE and in-hospital mortality.
Answers are grounded in this paper and cite their sources.
Identifies candidate modifiable risks for suboptimal flow in STEMI PCI; hypothesis-generating and requires prospective validation before practice change.
Background and aim: Suboptimal coronary blood flow following first percutaneous coronary intervention (PCI) is a multivariate phenomenon with several causes. Despite substantial research, recognized modifiable risk factors and an effective management plan are lacking. The present study intended to determine the several causes of suboptimal coronary blood flow during primary percutaneous intervention. Patients and Method: A retrospective study was carried out on 486 STEMI patients in the Interventional Cardiology Department, MTI-Hayatabad Medical Complex, Peshawar from June 2021 to May 2022. Patients (age>20 years) presented with initial percutaneous coronary intervention within 12 hours after onset of symptoms were enrolled. Patients’ physical examination, medical history, different risk factors, vital signs assessment, echocardiography, Killip class, laboratory investigation, and post-procedural ECG were recorded along with PCI data and associated catheterization. Clinical outcomes included MACE, ischemia-driven target vessel revascularization, reinfection, cardiac mortality, and post-catheterization were recorded. Descriptive statistics was done in SPSS version 26. Results: Of the total 486 STEMI patients, there were 412 (84.8%) male and 74 (15.2%) females. The overall mean age was 52.62± 8.64 years. The incidence of suboptimal flow (TIMI flow ≤2) and optimal flow (TIMI-3 flow) were 112 (23%) and 374 (77%) respectively. Age [OR 1.041/year: p<0.001], total stent length [OR 1.019 per 1 mm], low SBP [OR 1.021 per mm Hg], thrombus burden grade [OR 1.78], and baseline TIMI flow (≤1) [OR 1.72; p=0.021] were suboptimal flow independent predictors. Cardiac mortality and MACE were significantly higher after 30-days in suboptimal flow as compared to optimal flow. The prevalence of in-hospital mortality in suboptimal flow and optimal flow was 9.1% and 2.1% respectively. Conclusion: The present study found that suboptimal coronary flow after first PCI is substantially associated with higher in-hospital and cardiovascular mortality in STEMI. The most significant predictor of poor coronary flow is predilatation prior to stenting.
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Khan et al. (2022) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=486). Thrombus burden grade vs. Lower thrombus burden was evaluated on Suboptimal coronary blood flow (TIMI flow ≤2) (OR 1.78, p=0.019). Suboptimal coronary blood flow occurred in 23% of STEMI patients after primary PCI and was independently predicted by heavy thrombus burden (OR 1.78), baseline TIMI flow ≤1 (OR 1.72), older age, longer stent length, and low systolic blood pressure.
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