Staff Members - Benha University
Predictors of Suboptimal Coronary Blood Flow After Primary Angioplasty and Its Implications on In-Hospital Clinical Outcomes in Patients With Acute Anterior Wall Myocardial Infarction
Jacc-Cardiovascular Interventions • 2020
Publication Information
Authors
Elakabawi K, Guo N, Mintz GS, Yuan ZY
Keywords
Not Available
Journal
Jacc-Cardiovascular Interventions
Publisher
Not Available
Volume
Not Available
Issue
Not Available
Pages
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publication.type
International
Paper Link
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Supplementary Materials
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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 1mm 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
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 1mm 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