Predictors of suboptimal coronary blood flow after primary angioplasty and its implications on short-term outcomes in pa
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(2020) 20:391
RESEARCH ARTICLE
Open Access
Predictors of suboptimal coronary blood flow after primary angioplasty and its implications on short-term outcomes in patients with acute anterior STEMI Karim Elakabawi1,2, Xin Huang1, Sardar Ali Shah1, Hameed Ullah1, Gary S. Mintz3, Zuyi Yuan1*
and Ning Guo1*
Abstract Background: Suboptimal coronary blood flow after primary percutaneous coronary intervention (PCI) is a complex multifactorial phenomenon. Although extensively studied, defined modifiable risk factors and efficient management strategy are lacking. This study aims to determine the potential causes of suboptimal flow and associated impact on 30-day outcomes in patients presenting with anterior ST-elevation myocardial infarction (STEMI). Methods: We evaluated a total of 1104 consecutive patients admitted to our hospital from January 2016 to December 2018 with the diagnosis of anterior wall STEMI who had primary PCI. Results: Overall, 245 patients (22.2%) had final post-PCI TIMI flow ≤2 in the LAD (suboptimal flow group) and 859 (77.8%) had final TIMI-3 flow (optimal flow group). The independent predictors of suboptimal flow were thrombus burden grade (Odds ratio (OR) 1.848; p < 0.001), age (OR 1.039 per 1-year increase; p < 0.001), low systolic blood pressure (OR 1.017 per 1 mmHg decrease; p < 0.001), total stent length (OR 1.021 per 1 mm increase; p < 0.001), and baseline TIMI flow ≤1 (OR 1.674; p = 0.018). The 30-day rates of major adverse cardiovascular events (MACE) and cardiac mortality were significantly higher in patients with TIMI flow ≤2 compared to those with TIMI-3 flow (MACE: adjusted risk ratio [RR] 2.021; P = 0.025, cardiac mortality: adjusted RR 2.931; P = 0.031). Conclusion: Failure to achieve normal TIMI-3 flow was associated with patient-related (age) and other potentially modifiable risk factors (thrombus burden, admission systolic blood pressure, total stent length, and baseline TIMI flow). The absence of final TIMI-3 flow carried worse short-term clinical outcomes. Keywords: Anterior STEMI, Primary PCI, TIMI flow, Short-term outcomes
Background Primary percutaneous coronary intervention (PCI) remains the best option for patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) [1]. While the success rate in the reopening of the thrombotic occlusion can reach up to 95% [2, 3], * Correspondence: [email protected]; [email protected] 1 Cardiovascular Department, First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, Xi’an 710061, Shaanxi, China Full list of author information is available at the end of the article
failure to restore optimal blood flow in the infarctrelated coronary artery (i.e., less than thrombolysis in myocardial infarction [TIMI]-3 flow [4]) has been noted in 5–23% of patients and has been associated with adverse clinical outcomes [3, 5, 6]. Many mechanisms have been hypothesized to explain this phenomenon, including the obstruction of epicardial coronary vessels (residual stenosis, thrombus, or dissection) and the d
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