Predictors and long-term prognostic significance of angiographically visible distal embolization during primary...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Primary percutaneous coronary intervention (p-PCI) is the preferred reperfusion strategy for ST-segment elevation myocardial infarction (STEMI).
• Distal embolization can occur during p-PCI, potentially impacting clinical outcomes.
• Identifying predictors and consequences of angiographically visible distal embolization (AVDE) is crucial for optimizing STEMI management.

Purpose of the Study:

• To determine the predictors of AVDE during p-PCI in STEMI patients.
• To evaluate the impact of AVDE on short- and long-term clinical outcomes in this patient population.

Main Methods:

• Retrospective analysis of 2007 STEMI patients undergoing p-PCI.
• Assessment of clinical and angiographic characteristics to identify AVDE predictors.
• Comparison of clinical outcomes between patients with and without AVDE.

Main Results:

• AVDE occurred in 6.7% of patients.
• Independent predictors of AVDE included older age, right coronary artery treatment, repeated balloon dilatation, cut-off occlusion pattern, longer lesion length (>15 mm), and larger reference vessel diameter (>3.5 mm).
• Patients with AVDE exhibited higher in-hospital (8.1% vs. 3.8%) and one-month (10.8% vs. 4.9%) all-cause mortality, as well as increased long-term all-cause (21.5% vs. 10.4%) and cardiac mortality (18.4% vs. 8.0%).

Conclusions:

• AVDE is a significant complication during p-PCI for STEMI.
• AVDE is associated with adverse short- and long-term clinical outcomes, including increased mortality.
• These findings underscore the importance of recognizing and potentially mitigating AVDE during STEMI interventions.