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Risk Factors of Reperfusion Failure following Primary Angioplasty for ST-Segment Elevation Myocardial Infarction
Hamid Reza Sanati1, Mohammad Parsa Mahjoob2, Ali Zahedmehr1
1Cardiovascular Intervention Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
Suboptimal reperfusion after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is linked to symptom onset time and ejection fraction. Early intervention and risk factor management are key for better outcomes in STEMI patients undergoing PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- Percutaneous coronary intervention (PCI) is superior to thrombolysis for ST-elevation myocardial infarction (STEMI) but optimal myocardial reperfusion is not always achieved.
- A significant portion of STEMI patients undergoing primary PCI experience suboptimal myocardial reperfusion, necessitating further investigation into contributing factors.
Purpose of the Study:
- To identify factors associated with failed myocardial reperfusion following primary PCI in patients diagnosed with STEMI.
- To analyze the relationship between reperfusion failure and clinical, demographic, and angiographic variables.
Main Methods:
- Retrospective analysis of 155 STEMI patients who underwent primary PCI.
- Evaluation of variables including age, sex, cardiac risk factors, symptom onset time, ejection fraction, and prior cardiac history.
- Multivariate analysis to determine significant predictors of reperfusion failure.
Main Results:
- Procedural success rate was 97.1%, with complete ST resolution in 43.2% of patients.
- Multivariate analysis identified symptom onset time (p=0.044) and ejection fraction (p=0.050) as significant factors inversely associated with failed reperfusion.
- Male gender showed a direct association with failed reperfusion (p=0.068). Culprit vessel being the right coronary artery correlated with better ST resolution (p=0.001).
- Presence of more than three cardiac risk factors was associated with failed reperfusion (p=0.050).
Conclusions:
- Time of symptom onset and ejection fraction are crucial predictors of myocardial reperfusion success after primary PCI in STEMI.
- Accumulation of cardiac risk factors also plays a role in predicting reperfusion failure.
- These findings can inform more aggressive therapeutic strategies for STEMI patients at high risk for suboptimal reperfusion.
Background:
Although percutaneous coronary intervention (PCI) improves outcomes compared to thrombolysis, a substantial number of ST-elevation myocardial infarction (STEMI) patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI.
Methods:
Totally, 155 patients (124 men; mean age = 56.6 ± 11.03 years, range = 31- 85 years) with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed.
Results:
Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GPIIb/IIIa inhibitor were not the determining factors (p value > 0.05). According to our multivariate analysis, time of symptom onset (OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044) and ejection fraction (OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050) had reverse and male gender had direct significant associations with failed reperfusion (OR [95% CI]: 0.34 [0.11 to 1.08]; p value = 0.068). More degrees of ST resolution occurred when the right coronary artery was the culprit vessel (p value = 0.001). The presence of more than three cardiac risk factors was associated with failed reperfusion (p value = 0.050).
Conclusion:
Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a more aggressive therapeutic strategy.
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