PREDILATION BALLOONING IN HIGH THROMBUS LADEN STEMIS: AN INDEPENDENT PREDICTOR OF SLOW FLOW/NO-REFLOW IN PATIENTS UNDERGOING EMERGENT PERCUTANEOUS CORONARY REVASCULARIZATION
Main Article Content
Keywords
STEMI, primary PCI, predilation ballooning, slow-flow, no-reflow, thrombus burden, intraprocedural complications, emergent percutaneous coronary revascularization
Abstract
Background: ST-segment elevation myocardial infarction (STEMI) is a critical presentation of acute myocardial infarction. Primary percutaneous coronary intervention (pPCI) is the recommended treatment to restore forward blood flow. However, the occurrence of slow-flow/no-reflow (SF/NR) can limit optimal reperfusion, affecting patient outcomes. Among various factors, high thrombus burden (≥4 grade) has been linked to SF/NR.
Objective: This study evaluates the impact of predilation ballooning on the incidence of intraprocedural SF/NR during primary PCI in patients with high thrombus burden.
Material and Methods: This cross-sectional study was conducted at the Department of Cardiology, Federal Govt Polyclinic Hospital, Islamabad, between August 2020 and July 2021. A total of 250 STEMI patients undergoing pPCI with angiographic evidence of high thrombus burden (≥4 grade) were included. Patients were divided into two groups based on the use of predilation ballooning (n = 125 each). Propensity score matching ensured comparability of clinical profiles. Data analysis was performed using IBM SPSS, with p ≤ 0.05 considered statistically significant.
Results: Patients in the ballooning group exhibited older age, longer ischemic times, higher heart rates, and more advanced Killip class at presentation. They also had a greater prevalence of diabetes, multivessel disease, and complex coronary anatomy. Predilation ballooning significantly increased the incidence of SF/NR (41.3% vs. 27.4%, p < 0.001). Despite achieving similar final TIMI III flow rates, the ballooning group experienced higher in-hospital mortality (8.1% vs. 4.1%, p = 0.018) and a trend toward increased contrast-induced nephropathy.
Conclusion: Predilation ballooning is an independent predictor of intraprocedural SF/NR and is associated with higher in-hospital mortality in STEMI patients with high thrombus burden. These findings emphasize the need to avoid predilation ballooning and minimize procedural hardware to optimize outcomes in this high-risk population.
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Dr. Muhammad Abdul Wahab
MBBS, FCPS-Cardiology, Associate Physician of Cardiology, Federal Govt Polyclinic Hospital, Islamabad
Dr. Mashooque Ali Dasti
MBBS. DIP (Cardiology) MD (Cardiology), Post Fellowship Interventional Cardiology, Associate Professor of NICVD/SICVD, Sehwan
Dr. Atif Khan
MBBS, FCPS (Intervention Cardiology), Assistant Professor, National Institute of Cardiovascular Diseases (NICVD), Hyderabad
Dr. Rizwan Khan
MBBS, FCPS Cardiology, FCPS Interventional Cardiology, Assistant Professor of Cardiology, NICVD/SICVD Sehwan
Dr. Muzafar Ali Surhio
MBBS, FCPS, MRCP, FRCP, Consultant Cardiologist, King Abdul Aziz Air Base, Armed Forces Hospital, Dhahran
Dr. Amjad Ali Hulio
MBBS, MD (Cardiology), Fellowship Interventional Cardiology, Assistant Professor of Cardiology, NICVD, Larkana