PREDICTORS OF SUBOPTIMAL CORONARY BLOOD FLOW DURING PRIMARY PERCUTANEOUS INTERVENTION
Main Article Content
Keywords
Predictors, uboptimal Coronary Blood Flow, Primary Percutaneous Intervention
Abstract
Background: Primary percutaneous coronary intervention (PCI) remains the best option for patients presenting with an acute ST-segment elevation myocardial infarction (STEMI). While the success rate in the reopening of the thrombotic occlusion can reach up to 95% , failure to restore optimal blood flow in the infarct-related coronary artery (i.e., less than thrombolysis in myocardial infarction [TIMI]-3 flow has been noted in 5–23% of patients and has been associated with adverse clinical outcomes.
Objective: Predictors of Suboptimal Coronary Blood Flow during Primary Percutaneous Intervention
Methodology: The current retrospective study was done at the department of cardiology Sandeman provincial hospital quetta, Quetta. The current study was carried out from July 2022 to November 2022 after taking approval from the ethical review committee. Patient’s physical examination, medical history, different risk factors, vital signs assessment, Killip class, echocardiography, laboratory investigation, and post-procedural ECG were recorded along with PCI data and associated catheterization. Risk factors associated clinical history included age, diabetes, gender, smoking, hypertension, myocardial infarction, hypercholesterolemia, family history of cardiovascular disease, and PCI were recorded. Laboratory findings regarding cardiac catheterization were recorded. ECG (12-lead) were performed in each individual after hospitalization. The data was analyzed using SPSS version 24.
Results: In the current study a total of 200 STEMI patients were enrolled. The male patients were 170 (85%) while female patients were 30 (15%). The mean age (SD) was 55 (±6.11) years. The frequency of suboptimal flow (TIMI flow ≤2) was 50 (25%) and optimal flow (TIMI-3 flow) was 150 (75%). The suboptimal flow independent predictors were Age [OR 1.055/year: p<0.000], total stent length [OR 1.011 per 1 mm], low SBP [OR 1.029 per mm Hg], thrombus burden grade [OR 1.81], and baseline TIMI flow (≤1) [OR 1.86; p=0.001]. The prevalence of in-hospital mortality in suboptimal flow was 22 (11) % and in optimal flow it was 6 (3)%.
Conclusion: The present study found that suboptimal coronary flow after first PCI is substantially associated with higher in-hospital and long- term cardiovascular mortality in STEMI. The most significant predictor of poor coronary flow is predilatation prior to stenting.”
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Abdul Ghaffar Khan
Associate Professor Cardiology SPH/BMCH Quetta
Dost Muhammad Barech
Assistant Professor Cardiology SPH/BMCH Quetta
Muhammad Assa
Senior Registrar Cardiology SPH/BMCH Quetta
Fazal Ur Rehman
Associate Professor Cardiology SPH/BMCH Quetta