Introduction: In this study we aimed to investigate the clinical and angiographic characteristics of ST-elevation myocardial infarction patients with primary percutaneous coronary intervention failure.
Methods: This was a retrospective observational study 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 to 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: TIMI flow 3 was achieved in 499 (91.1%) patients after the procedure while 49 (8.9%) patients developed TIMI ≤ 2. Our findings showed that cTFC ≥ 28 was present in 50 (9.1%) patients while 489 (89.2%) patients had cTFC < 28. In multivariable analysis, after adjustment with possible confounders, we found that older age [odds ratio (OR) = 1.04, 95% confidence interval (CI) 1.01 to 1.07], longer pain onset to first medical contact time (OR = 1.04, 95% CI 1.00 to 1.18), and left anterior descending artery involvement (OR = 3.15, 95% CI 1.21 to 8.11) were independent predictors of TIMI ≤ 2.
Conclusion: Even though TIMI ≤ 2 was uncommon among our study population, it was associated with adverse in-hospital outcomes. Our results indicate that earlier emergency medical service arrival and shorter transfer time to referral center can dramatically reduce the primary percutaneous coronary intervention failure rate.