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Published on: January 28, 2020
Coronary cyclic flow variations following primary angioplasty is associated with poor short-term prognosis
Mariano Albertal1, Fernando Cura, Mitchell W Krucoff
1Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. malbertal@fibertel.com.ar
Insights
Coronary cyclic flow variations (CCFV) after percutaneous coronary intervention (PCI) in ST-segment Elevation Myocardial Infarction (STEMI) patients indicate a higher risk of mortality and major adverse cardiac events within 30 days. This finding suggests CCFV can predict poor outcomes post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Coronary cyclic flow variations (CCFV) are a platelet-related phenomenon observed after reperfusion.
- While CCFV predicts complications after thrombolytic therapy, its significance after percutaneous coronary intervention (PCI) remains unevaluated.
Purpose of the Study:
- To assess the impact of CCFV on major adverse cardiac events (MACE) in ST-segment Elevation Myocardial Infarction (STEMI) patients undergoing primary PCI.
- To determine if CCFV is an independent predictor of adverse outcomes following PCI.
Main Methods:
- A cohort of 131 STEMI patients undergoing PCI were monitored for 24 hours.
- CCFV was defined as >= 3 ST-segment transitions (>= 150 microV).
- Multivariate logistic regression analyzed the association between CCFV and 30-day MACE, adjusting for clinical and angiographic factors.
Main Results:
- 14.6% of patients developed CCFV.
- The CCFV group exhibited significantly higher 30-day mortality (21.4% vs. 3.8%) and MACE rates (42.9% vs. 10.7%).
- CCFV was an independent predictor of 30-day MACE (adjusted RR 5.09; p=0.0016).
Conclusions:
- The presence of CCFV after primary PCI in STEMI patients is associated with significantly increased short-term mortality and MACE.
- CCFV may serve as an early indicator of inadequate myocardial perfusion and predict adverse outcomes post-PCI.
Aims:
Recent studies have shown that coronary cyclic flow variations (CCFV) is a platelet-related phenomenon that occurred following reperfusion. Although CCFV predicts acute complications following thrombolytic therapy, its impact following percutaneous coronary interventions (PCI) has not been evaluated yet.
Methods And Results:
One hundred and thirty-one patients with ST-segment Elevation Myocardial Infarction (STEMI) who underwent PCI were included in the analysis. All patients have 24-hour ST-segment monitoring. The development of CCFV was defined as > or = 3 ST-segment transitions (> or =150 microV). We divided the population in two groups according to the presence (n=14, 10.6%) or absence (n=117) of CCFV. The relation between CCFV and 30-day major adverse cardiac events (MACE) was analyzed using a multivariate logistic regression model adjusting for age, sex, diabetes, smoking, anterior infarct, Killip class, and final TIMI flow grade. Clinical and angiographic characteristics were similar between the two groups. Higher 30-day mortality (21.4 vs. 3.8%, p=0.022) and MACE rates (42.9 vs. 10.7%, p=0.005) were seen in the CCFV group. Multivariate regression analysis revealed that patients with CCFV were at increased risk of 30-day MACE (adjusted RR 5.09; 95% CI 1.3-19.1; p=0.0016).
Conclusion:
The presence of CCFV altered primary PCI may provide an early indication of insufficient myocardial perfusion and impending catastrophic outcome.
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