Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction

Abstract

In percutaneous coronary intervention (PCI) to the culprit lesion of acute myocardial infarction (AMI), unsuccessful guidewire crossing causes immediate poor outcomes. It is important to determine the factors associated with unsuccessful guidewire crossing in AMI lesions. The purpose of this study was to find factors associated with difficulty in crossing the culprit lesion of AMI. We defined the difficult group when the guidewire used to cross the culprit lesion was a polymer jacket type guidewire or a stiff guidewire. We included 937 patients, and divided those into the non-difficult group (n = 876) and the difficult group (n = 61). Proximal reference diameter was significantly smaller in the difficult group than in the non-difficult group (p < 0.001), and degree of calcification was severer in the difficult group than in the non-difficult group (p < 0.001). In the multivariate stepwise logistic regression analysis, proximal reference diameter [odds ratio (OR) 0.313, 95% confidence interval (CI) 0.185–0.529, p < 0.001)], previous PCI (OR 3.065, 95% CI 1.612–5.830, p = 0.001), moderate-severe calcification (OR 4.322, 95% CI 2.354–7.935, p < 0.001), blunt type obstruction (OR 12.646, 95% CI 6.805–23.503, p < 0.001), and the presence of collateral to the culprit lesion (OR 2.110, 95% CI 1.145–3.888, p = 0.017) were significantly associated with difficulty in crossing the culprit lesion. In conclusion, previous PCI, calcification, blunt type obstruction, and the presence of collateral were associated with difficulty in crossing the culprit lesion, whereas proximal reference diameter was inversely associated with difficulty. Our study provides a reference to recognize the difficulty in crossing the culprit lesions of AMI for PCI operators, especially junior operators.

Intravascular ultrasound-guided dissection recanalization in a patient with ST-segment elevation myocardial infarction: a case report

“…Approximately 7% of AMI lesions required a polymer jacket-type or stiff guidewire to cross the culprit lesion. 4 Herein, there was a septal collateral channel from the LAD to the RCA, and post-revascularization electrocardiogram showed pathological Q-waves in the inferior lead. This implied that severe stenosis happened before complete occlusion occurred at AMI onset.…”

Appetite Predicts Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

“…The definition of AMI was based on the universal definition of AMI [18]. The definition of comorbidities including hypertension, dyslipidemia, and diabetes mellitus was reported elsewhere [19,20]. We collected information including body mass index, systolic blood pressure, diastolic blood pressure, heart rate at admission, hemodialysis, history of PCI, history of myocardial infarction (MI), history of coronary artery bypass graft surgery, smoking status, and medication before admission.…”

“…We measured quantitative coronary angiography (QCA) parameters using QAngio XA 7.3 (MEDIS, Leiden, Netherlands). These parameters were calculated after the achievement of reperfusion if the lesion was totally occluded [19]. We also recorded the initial and final TIMI flow grades from coronary angiography.…”

A Practical Technique to Advance Stent Through Uncrossable Coronary Lesions: A Prospective Cohort Study

“…Fifteen variables characterizing the severity and morphology of each coronary stenosis were assessed based on angiographic definitions used in recent scientific reports and modified The American College of Cardiology/American Heart Association (ACC/AHA) systematized coronary stenosis-specific classification. 5,[13][14][15][16] The pa- tient was excluded from the study if insufficient information was available to apply the defined criteria. All confirmers, reviewers, and abstracters were blinded to the study.…”