Clinical factors associated with slow flow in left main coronary artery-acute coronary syndrome without cardiogenic shoc
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ORIGINAL ARTICLE
Clinical factors associated with slow flow in left main coronary artery‑acute coronary syndrome without cardiogenic shock Kei Yamamoto1 · Kenichi Sakakura1 · Takunori Tsukui1 · Masaru Seguchi1 · Yousuke Taniguchi1 · Hiroshi Wada1 · Shin‑ichi Momomura1 · Hideo Fujita1 Received: 3 August 2020 / Accepted: 29 September 2020 © Japanese Association of Cardiovascular Intervention and Therapeutics 2020
Abstract Since slow flow can be a fatal complication in left main coronary artery (LMCA)-acute coronary syndrome (ACS) patients, it should be important to anticipate and prepare slow flow during primary PCI for LMCA-ACS. We hypothesized that intravascular ultrasound (IVUS) findings would be useful to predict slow flow for LMCA-ACS patients without cardiogenic shock (CS). The purpose of this study was to investigate clinical factors associated with slow flow in LMCA-ACS patients without CS. We included 60 LMCA-ACS patients without CS, and divided into the slow flow group (n = 18) and the nonslow flow group (n = 42). Slow flow was defined as either transient or persistent TIMI flow grade ≤ 2. The prevalence of ST-segment elevation myocardial infarction (STEMI) was significantly higher in the slow flow group (55.6%) than in the non-slow flow group (11.9%) (p = 0.002). In the IVUS analysis, remodeling index was significantly greater in the slow flow group (1.15 ± 0.17) than in the non-slow flow group (0.99 ± 0.11) (p = 0.001). The multivariate logistic regression analyses in the IVUS factors revealed that remodeling index was significantly associated with slow flow (0.1 increase: OR 2.238, 95% CI 1.144–4.379, p = 0.019). In conclusion, remodeling index was significantly associated with slow flow. Our results suggest that the remodeling index determined by IVUS would be useful to find high-risk features of slow flow in LMCAACS patients without CS. Keywords Left main coronary artery · Percutaneous coronary intervention · Intravascular ultrasound · Remodeling index · Cardiogenic shock
Introduction In the current percutaneous coronary interventions (PCI), intravascular ultrasound (IVUS) plays an important role for precise procedures [1, 2]. In fact, PCI with IVUS guidance has shown favorable outcomes compared to angiographic guidance [3–5]. Since the development of devices and procedures have improved the outcomes of complex coronary lesions [6, 7], PCI to left main coronary artery (LMCA)lesions has been more frequently performed in the current PCI [8]. Although it is well known that LMCA-AMI patients with cardiogenic shock (CS) had the highest mortality [9, 10], the mortality of LMCA-AMI patients without CS was * Kenichi Sakakura [email protected] 1
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1‑847 Amanuma‑cho, Omiya‑ku, Saitama, Saitama 330‑8503, Japan
nearly twice as high as that of non-LMCA-AMI patients without CS [11]. Slow flow following stent implantation is a serious complication associated with poor outcomes in acute coronary syndrome (ACS) patients
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