The impact of clinical and angiographic factors on percutaneous coronary angioplasty outcomes in patients with acute ST-elevation myocardial infarction

Abstract

<b>Introduction: </b> Percutaneous coronary intervention (PCI) outcomes are dependent on certain clinical and angiographic factors. The impact of modifiable cardiovascular disease (CVD) risk factors on PCI outcomes is still controversial. The aim of the study was to evaluate the impact of clinical and angiographic factors on PCI outcomes for patients with acute ST-elevation myocardial infarction (STEMI). <br /> <b>Material and methods</b>: Age, gender, CVD risk factors, Killip class and culprit coronary artery (CA) localization, total CA occlusion, initial and post-procedural thrombolysis in myocardial infarction (TIMI) flow grade, and thrombus aspiration characteristics were assessed retrospectively in 188 consecutive patients with STEMI who underwent primary PCI. Spearman’s rho test was performed to assess hospital stay correlations, and logistic regression was applied to identify predictors of distal embolization (DE), in-hospital worsening of heart failure (WHF), and in-hospital mortality rate. Local ethics committee approval was obtained for the study. <br /> <b>Results</b>: DE occurred in 12 (6.4%) patients. In-hospital WHF was diagnosed in 16 (8.5%) patients. Twelve (6.4%) patients died in hospital. Age had a positive weak correlation with hospital stay and was an independent predictor of distal embolization, in-hospital worsening of heart failure, and in-hospital mortality rate. Killip class, left main CA stenosis (> 50.0%), and post-procedural TIMI flow grade 1-2 were other predictors of death in hospital. <br /> <b>Conclusions</b>: Age was an independent predictor of distal embolization, in-hospital worsening of heart failure, and in-hospital mortality. Other independent predictors of in-hospital mortality rate were Killip class, left main CA stenosis (> 50.0%), and post-procedural TIMI flow grade 1-2. The present analysis highlighted the “cholesterol paradox” with respect to in-hospital worsening of heart failure and mortality in hospital.

Risk Factors of Suboptimal Coronary Blood Flow after a Percutaneous Coronary Intervention in Patients with Acute Anterior Wall Myocardial Infarction

“…Failure to restore optimal blood flow in the infarct-related artery is not very common and can been observed in 5–23% of patients. Nevertheless, suboptimal coronary blood flow (TIMI ≤ 2) after PCI in patients with acute myocardial infarction is related to higher mortality and worse short- as well as long-term clinical outcomes [ 5 , 6 , 7 , 8 ]. The potential mechanisms of non-optimal blood flow post-PCI may be either epicardial coronary artery obstruction or disturbances in microvascular circulation and function of epithelium associated with distal embolisation during PCI, reperfusion injury and inflammatory response [ 5 , 9 , 10 ].…”

Water on Fire: The Patients’ Lived Experience of Primary Percutaneous Coronary Intervention

“…The PPCI results in a reduction of reinfarction rate, shorter hospitalization, and mortality. Nevertheless, the progress and high success rate of the treatment is influenced by many factors such as age, renal function, left ventricular function, and anatomical complexity of coronary artery disease (4)(5)(6)(7).…”