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Can Syntax Score predict angiographically visible distal embolization during primary percutaneous coronary
Ismail Biyik1, Ibrahim F Akturk, Derya Ozturk
1Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey - ismailbiyikmd@yahoo.com.
Insights
Low Syntax Score, longer stent length, and low left ventricular ejection fraction predict distal embolization during percutaneous coronary intervention for ST-elevation myocardial infarction. These factors are linked to thrombus burden and plaque composition, not complex lesions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Primary percutaneous coronary intervention (PPCI) is standard for ST-elevation myocardial infarction (STEMI).
- Achieving normal myocardial perfusion post-PPCI remains a challenge for some STEMI patients.
- Angiographically visible distal embolization (AVDE) can compromise outcomes.
Purpose of the Study:
- To identify angiographic and procedural predictors of AVDE during PPCI.
- To assess the impact of AVDE on mid and long-term mortality.
Main Methods:
- A cohort of 465 STEMI patients undergoing PPCI was analyzed.
- Patients were categorized into groups with (n=61) and without (n=404) AVDE based on intra-procedural angiograms.
Main Results:
- Univariate analysis identified longer stent length, higher balloon diameter, low Syntax Score (SxS), low left ventricular ejection fraction (LVEF), high neutrophil/lymphocyte ratio, and chronic renal failure as potential AVDE predictors.
- Multivariate analysis confirmed stent length, LVEF, and low SxS as significant predictors of AVDE.
Conclusions:
- Low Syntax Score, longer stent length, and low LVEF are independent predictors of AVDE in STEMI patients undergoing PPCI.
- The association of low SxS with AVDE suggests a link to high thrombus burden and plaque composition, rather than lesion complexity.
Background:
Primary percutaneous coronary intervention (PPCI) is the most effective and validated treatment strategy of ST segment elevation myocardial infarction (STEMI). Nevertheless, normal myocardial perfusion cannot always be achieved at the end of the procedure in a significant number of patients with STEMI. The aim of this study was to investigate angiographic and procedural predictors of angiographically visible distal embolization (AVDE) during PPCI and the assessment of mid and long term mortality.
Methods:
Four hundred and sixty five consecutive patients undergoing PPCI for acute STEMI and matching eligibility criteria of the study between January 2010 and December 2011 were enrolled in the study. Patients were divided into two groups; 61 (13.1%) with AVDE and 404 patients without AVDE based on angiograms performed during PPCI.
Results:
Longer stent length, higher balloon diameter, low Syntax score (SxS), low LVEF, high neutrophil/lymphocyte ratio and chronic renal failure were seemed to be associated with AVDE in univariate analysis and these variables were entered into multivariate analysis. In multivariate analyzes, stent length, LVEF and low SxS were found to be associated with AVDE (OR: 1,11, 95 % CI: 1,06-1,16, p< 0,001; OR: 0,80, 95%CI: 0.80-0.91, p< 0,001; OR: 0,85, 95%CI: 0,79-0,91, P< 0,001, respectively).
Conclusions:
This study concluded that low SxS, longer stent length, low LVEF were predicting risk factors associated with the development of AVDE in patients undergoing PPCI. Low SxS associated with AVDE may be linked to the strong relation between AVDE and high thrombus burden and composition of atherosclerotic plaque rather than complex coronary lesions.
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