Related Experiment Video
Updated: Jul 14, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
The effects of facilitated primary PCI by guide wire on procedural and clinical outcomes in acute ST-segment
Volkhard Kurowski1, Evangelos Giannitsis, Dirk P Killermann
1Medizinische Klinik II, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Insights
Guide wire facilitated reperfusion of the infarct related artery (IRA) in ST-segment elevation myocardial infarction (STEMI) patients is linked to better procedural success and improved survival. This method offers significant clinical benefits in primary PCI.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Acute Myocardial Infarction Research
Background:
- Reperfusion of the infarct-related artery (IRA) before percutaneous coronary intervention (PCI) is critical for acute ST-segment elevation myocardial infarction (STEMI) outcomes.
- Reperfusion strategies include spontaneous, GP IIb/IIIa inhibitor-facilitated, or mechanical guide wire crossing.
- This study investigates the association between guide wire-facilitated reperfusion and procedural/clinical outcomes in STEMI.
Purpose of the Study:
- To evaluate the frequency and prognostic impact of guide wire-facilitated reperfusion of the IRA before primary PCI in STEMI patients.
- To test the hypothesis that visible coronary anatomy is independently associated with procedural and clinical outcomes.
Main Methods:
- A consecutive series of 311 STEMI patients undergoing primary PCI within 12 hours of symptom onset were analyzed.
- Patients were categorized based on reperfusion timing: spontaneous, guide wire-facilitated, or post-PCI.
- Clinical and procedural data, including fluoroscopic time, contrast use, procedural success, and mortality, were collected and compared.
Main Results:
- 28.9% had spontaneous reperfusion, 18.0% achieved reperfusion via guide wire crossing, and 53.1% reperfused after PCI.
- Guide wire-facilitated reperfusion was associated with younger age, no hypertension, active smoking, negative troponin T, and right coronary artery infarcts.
- Patients with spontaneous or guide wire-facilitated reperfusion had shorter fluoroscopic times, less contrast use, higher procedural success rates (91.1% vs. 79.4%), and lower 30-day and long-term mortality (3.6% vs. 13.9%).
Conclusions:
- Reperfusion by guide wire crossing before PCI is linked to enhanced procedural success and improved patient outcomes.
- Potential mechanisms include improved roadmapping and device selection, though the exact reasons require further elucidation.
- Guide wire-facilitated reperfusion represents a valuable strategy in managing STEMI patients.
Background:
Reperfusion of the infarct related artery (IRA) prior to PCI is prognostically important in patients with acute ST segment elevation myocardial infarction (STEMI). Reperfusion is either achieved spontaneously, facilitated by GP IIb/ IIIa inhibitors, or mechanically by crossing the guide wire beyond the lesion. In order to test the hypothesis that a visible coronary anatomy is independently associated with procedural and clinical outcomes, we evaluated the frequency and prognostic impact of guide wire facilitated reperfusion of the IRA before primary PCI.
Methods And Results:
We enrolled 311 consecutive patients with successful primary PCI for STEMI (TIMI grade > or =2 flow) within 12 h after onset of symptoms. Among these, 90 patients (28.9%) had a spontaneously reperfused IRA on initial angiogram, 56 patients (18.0%) achieved reperfusion after crossing of the guide wire, and 165 patients (53.1%) successful reperfusion only after PCI. Variables associated with successful guide wire facilitated reperfusion were younger age, no history of arterial hypertension, active smoking status, negative cardiac troponin T on admission, and an infarct in the territory of the right coronary artery. Patients with spontaneous reperfusion or reperfusion after crossing of the guide wire required less fluoroscopic time and less contrast material during angiography and had higher procedural success rates (TIMI grade 3 flow 91.1 vs 79.4%, p=0.048) than patients without initial reperfusion. In addition, patients with reperfusion after crossing the lesion with the guide wire had lower mortality rates at 30 days (3.6 vs 9.1%) and after a median of 16 months (3.6 vs 13.9%, p=0.03) than those with reperfusion after PCI.
Conclusions:
Reperfusion of an occluded IRA by crossing the guide wire is associated with higher procedural success rates and better outcomes. Better roadmapping and device selection represent potential reasons but the exact mechanism for these benefits is still illusive.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:27Coronary Artery Disease V: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations