Impact of Infarct Related Artery and Its Patency on the Outcomes of Patients Undergoing Primary Percutaneous Coronary Intervention

Background: Primary percutaneous coronary intervention (PCI) for acute myocardial infarction might be associated with suboptimal coronary flow with consequent poor functional recovery and higher rate of complications. Identification of the predictors of reperfusion failure can increase the rate of procedural success, preserve ventricular function and lessen mortality. We aimed to find the association between baseline coronary patency & culprit site with PCI outcome and the incidence of major adverse cardiac events (MACE). Methods: 46 STEMI patients treated by primary angioplasty were enrolled, then grouped according to the infarction related artery patency graded by TIMI flow. Over the next 3 months, patients were followed for the incidence of stent thrombosis, re-infarction, acute decompensated HF & death. Results: 27 patients had initial TIMI 0 flow and 19 patients had initial TIMI ≥1 flow.The proportion of satisfactory PCI outcome was 44.4% and 78.9% respectively (p=0.019). The later incidence of MACE was 66.7% and 21.1% respectively (p=0.002). The culprit vessel was LAD, LCX and RCA in 54.3%, 10.9% and 34.8% of the cases. When grouped based on the culprit, incidence of MACE was 68%, 20% and 25% (p=0.011). Multivariate logistic regression analysis found that initial TIMI 0 flow (p=0.013) and LAD as the infarction related vessel (p=0.032) were independent predictors for MACE. Conclusion: Initial infarction related artery patency at angiography has a direct impact on PCI outcome. Baseline TIMI 0 flow and LAD as a culprit site are independent predictors for major adverse cardiac events in STEMI patients undergoing primary angioplasty.