Document Type : Original Article
Authors
- Abbas Soleimani 1
- Sepehr Nayebi 2
- Haleh Ashraf 3
- Azadeh Sadat Naseri 1
- Alireza Oraii 2
- Sina Kazemian 2
- Roya Tayeb 1
- Fazeleh Majidi 4
- Mommadreza Fatahi 2
- Saeed Nateghi 5
- Shahrokh Karbalai Saleh 1
1 Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
3 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
4 Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
5 School of Medicine, Ziaeian Hospital, International Campus, Tehran University of Medical Sciences, Tehran, Iran
Abstract
INTRODUCTION: This study aimed to investigate the clinical and angiographic characteristics of patients with ST-elevation myocardial infarction who experienced primary percutaneous coronary intervention failure.
METHOD: This retrospective observational study was derived from the Primary Angioplasty Registry of Sina Hospital (PARS). A total of 548 consecutive patients with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention between November 2016 and January 2019 were evaluated. Percutaneous coronary intervention failure was defined as Thrombolysis in Myocardial Infarction (TIMI) flow ≤ 2 or corrected TIMI frame count (cTFC) ≥ 28.
RESULTS: The study population consisted of 458 (83.6%) males and 90 (16.4%) females with a mean age of 59.2 ± 12.49 years. TIMI flow 3 was achieved in 499 (91.1%) patients after the procedure, while 49 (8.9%) patients developed TIMI ≤ 2. The findings showed that cTFC ≥ 28 was present in 50 (9.1%) patients, while 489 (89.2%) patients had cTFC < 28. Multiple regression analysis shows that age 1.04 (1.01, 1.07), duration of pain onset to first medical contact time 1.04 (1.00, 1.18), and left anterior descending artery involvement 3.15 (1.21, 8.11) were independent predictors of TIMI ≤ 2.
CONCLUSION: Even though TIMI ≤ 2 was uncommon among the study population, it was associated with adverse in-hospital outcomes. The results indicate that earlier emergency medical service arrival and shorter transfer time to the referral center can dramatically reduce the primary percutaneous coronary intervention failure rate.
Highlights
The google Schoolar and PubMed links for Shahrokh Karbalai Saleh
The google Schoolar and PubMed links for Abbas Soleiman
https://scholar.google.com/citations?user=nIZfk-gAAAAJ&hl=en
https://pubmed.ncbi.nlm.nih.gov/?term=Abbas+soleimani
Keywords
2. Nakashima T, Yasuda S. Suboptimal Post-Procedural TIMI Flow in NSTEMI. Int Heart J 2017; 58(5): 645-646.
https://doi.org/10.1536/ihj.17-392
3. Elakabawi K, Huang X, Shah SA, Ullah H, Mintz GS, Yuan Z, et al. Predictors of suboptimal coronary blood flow after primary angioplasty and its implications on short-term outcomes in patients with acute anterior STEMI. BMC Cardiovasc Disord 2020; 20(1): 391.
https://doi.org/10.1186/s12872-020-01673-0
4. Man S, Xian Y, Holmes DN, Matsouaka RA, Saver JL, Smith EE, et al. Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients with Acute Ischemic Stroke. JAMA 2020; 323(21): 2170-2184.
https://doi.org/10.1001/jama.2020.5697
5. Brener SJ, Moliterno DJ, Aylward PE, van’t Hof AW, Ruźyllo W, O’Neill WW, et al. Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI angiographic study. Eur Heart J 2008; 29(9): 1127-1135. https://doi.org/10.1093/eurheartj/ehn125
6. Mehta RH, Harjai KJ, Cox D, Stone GW, Brodie B, Boura J, et al. Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol 2003; 42(10): 1739-1746. https://doi.org/10.1016/j.jacc.2003.07.012
7. Bauer T, Hochadel M, Brachmann J, Schächinger V, Boekstegers P, Zrenner B, et al. Use and outcome of radial versus femoral approach for primary PCI in patients with acute ST elevation myocardial infarction without cardiogenic shock: results from the ALKK PCI registry. Catheter Cardiovasc Interv 2015; 86 Suppl 1: S8-14. https://doi.org/10.1002/ccd.25987
8. Eshraghi A, Talasaz AH, Salamzadeh J, Bahremand M, Salarifar M, Nozari Y, et al. Study of the possible medical and medication explanatory factors of angiographic outcomes in patients with acute ST elevation myocardial infarction undergoing primary percutaneous intervention. Adv Biomed Res 2014; 3: 186. https://doi.org/10.4103/2277-9175.140096
9. Levi A, Kornowski R, Vaduganathan M, Eisen A, Vaknin-Assa H, Abu-Foul S, et al. Incidence, predictors, and outcomes of failed primary percutaneous coronary intervention: a 10-year contemporary experience. Coron Artery Dis 2014; 25(2): 145-151. https://doi.org/10.1097/MCA.0000000000000065
10. Zhou H, He XY, Zhuang SW, Wang J, Lai Y, Qi WG, et al. Clinical and procedural predictors of no-reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention. World J Emerg Med 2014; 5(2): 96-102. https://doi.org/10.5847/wjem.j.issn.1920-8642.2014.02.003
11. Dharma S, Mahavira A, Haryono N, Sukmawan R, Dakota I, Siswanto BB, et al. Association of Hyperglycemia and Final TIMI Flow with One-Year Mortality of Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI. Int J Angiol 2019; 28(3): 182-187. https://doi.org/10.1055/s-0039-1691811
12. Cenko E, Yoon J, Kedev S, Stankovic G, Vasiljevic Z, Krljanac G, et al. Sex Differences in Outcomes After STEMI: Effect Modification by Treatment Strategy and Age. JAMA Intern Med 2018; 178(5): 632-639. https://doi.org/10.1001/jamainternmed.2018.0514
13. Poldervaart JM, Langedijk M, Backus BE, Dekker IMC, Six AJ, Doevendans PA, et al. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. Int J Cardiol 2017; 227: 656-661. https://doi.org/10.1016/j.ijcard.2016.10.080
14. Gibson CM, Schömig A. Coronary and myocardial angiography: angiographic assessment of both epicardial and myocardial perfusion. Circulation 2004; 109(25): 3096-3105. https://doi.org/10.1161/01.CIR.0000134278.50359.CB
15. Karbalai Saleh S, Oraii A, Soleimani A, Saraee E, Ashraf H. The Primary Angioplasty Registry of Sina (PARS); A Brief Report of Design and Rationale. Front Emerg Med 2020; 5(1): e13. Front J Emerg Med. 2020;0(0). doi:10.22114/ajem.v0i0.531.
16. Konijnenberg LSF, Damman P, Duncker DJ, Kloner RA, Nijveldt R, van Geuns RM, et al. Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction. Cardiovasc Res 2020; 116(4): 787-805. https://doi.org/10.1093/cvr/cvz301
17. Dubey G, Verma SK, Bahl VK. Primary percutaneous coronary intervention for acute ST elevation myocardial infarction: Outcomes and determinants of outcomes: A tertiary care center study from North India. Indian Heart J 2017; 69(3): 294-298.
https://doi.org/10.1016/j.ihj.2016.11.322
18. Dai X, Hummel SL, Salazar JB, Taffet GE, Zieman S, Schwartz JB. Cardiovascular physiology in the older adults. J Geriatr Cardiol 2015; 12(3): 196-201. https://doi.org/10.11909/j.issn.1671-5411.2015.03.015
19. Costantini CO, Stone GW, Mehran R, Aymong E, Grines CL, Cox DA, et al. Frequency, correlates, and clinical implications of myocardial perfusion after primary angioplasty and stenting, with and without glycoprotein IIb/IIIa inhibition, in acute myocardial infarction. J Am Coll Cardiol 2004; 44(2): 305-312. https://doi.org/10.1016/j.jacc.2004.03.058
20. Kandzari DE, Tcheng JE, Gersh BJ, Cox DA, Stuckey T, Turco M, et al. Relationship between infarct artery location, epicardial flow, and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction. Am Heart J 2006; 151(6): 1288-1295. https://doi.org/10.1016/j.ahj.2005.08.017
21. Karwowski J, Gierlotka M, Gąsior M, Poloński L, Ciszewski J, Bęćkowski M, et al. Relationship between infarct artery location, acute total coronary occlusion, and mortality in STEMI and NSTEMI patients. Pol Arch Intern Med 2017; 127(6): 401-411. https://doi.org/10.20452/pamw.4018
22. Celik T, Kursaklioglu H, Iyisoy A, Kose S, Kilic S, Amasyali B, et al. The effects of prior use of atorvastatin on coronary blood flow after primary percutaneous coronary intervention in patients presenting with acute myocardial infarction. Coron Artery Dis 2005; 16(5): 321-326. https://doi.org/10.1097/00019501-200508000-00010
23. Lev EI, Kornowski R, Vaknin-Assa H, Ben-Dor I, Brosh D, Teplitsky I, et al. Effect of previous treatment with statins on outcome of patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol 2009; 103(2): 165-169. https://doi.org/10.1016/j.amjcard.2008.08.052
24. Patti G, Pasceri V, Colonna G, Miglionico M, Fischetti D, Sardella G, et al. Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention: results of the ARMYDA-ACS randomized trial. J Am Coll Cardiol 2007; 49(12): 1272-1278. https://doi.org/10.1016/j.jacc.2007.02.025
)