Objectives: Post-dilatation with non-compliant (NC) balloons is a commonly used strategy to improve inadequate stent expansion but this strategy carries an increased risk of slow flow/no-reflow (SF/NR) due to distal embolization. Therefore, our objective was to evaluate the demographic, clinical, angiographic, and procedure characteristics among patients undergoing primary percutaneous coronary intervention (PCI) who developed slow flow/no-reflow (SF/NR) after post-dilatation with non-compliant (NC) balloons. Methodology: In this cross-sectional observational study, we included consecutive patients with SF/NR after post-dilatation using NC balloon post stent deployment during primary PCI. The demographic, clinical, angiographic, and procedure characteristics were evaluated. Results: In the sample of 107 patients, male were 77.6% (83) and mean age was 56.94 ± 10.47 years. The median chest pain to ER (emergency room) arrival time was 292 [180-394] minutes. A majority of the patients (66.4%) had multi-vessel disease. Mean length NC balloon was 10.57±1.98 mm and diameter was 3.5±0.26 mm. The mean number of inflation were 3.62±1.08, at mean maximal pressure of 20.43±2.49 mmHg, proximal edge pressure of 19.25±2.74 mmHg, and distal edge pressure of 14.64±2.01 mmHg. A total of 5.6% (6) patients developed adverse events and final TIMI (thrombolysis in myocardial infarction) III flow was achieved in 89.7% (96) of the patients. Conclusion: SF/NR after post-dilatation during primary PCI is associated with a significant rate of adverse events and sub-optimal (<III) final TIMI flow. The detrimental effects of high pressure, short length, and increased number of inflations on post NC SF/NR need further investigations.
Objectives: In this study, we evaluated the differences in clinical and angiographic profiles of ST-segment elevation myocardial infarction (STEMI) patients with and without diabetes mellitus (DM) at a tertiary care cardiac hospital in Karachi, Pakistan. Methodology: This descriptive cross-sectional study was conducted at a tertiary care cardiac hospital in Karachi, Pakistan. The study included consecutive adult patients (≥ 18 years of age) diagnosed with STEMI undergoing primary percutaneous coronary intervention (PCI). Diabetic and non-diabetic patients were compared for clinical and angiographic profiles. Results: The study sample consisted of 43.8% (218) diabetic patients. The mean age was 59.03 ± 9.69 years vs. 49.54 ± 11.53 years; p<0.001, proportion of females was 35.3% (77) vs. 14.6% (41); p<0.001, Killip class III or IV was (17) vs. 2.5% (7), and hypertension was 83% (181) vs. 56.8% (159); p<0.001 among the diabetic and non-diabetic group, respectively. The frequency of multi-vessel disease was 50.9% (111) vs. 39.6% (111), the significant left main disease was 5% (11) vs. 2.5% (7), and initial TIMI III flow was 19.3% (42) vs. 25.4% (71) in diabetic and non-diabetic patients, respectively. Conclusion: In conclusion, diabetes in STEMI setting is associated with complex coronary artery diseases, more hemodynamic instability at presentation, and the presence of multiple co-morbid conditions.
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