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Coronary flow improvement following unsuccessful primary percutaneous coronary intervention in ST-elevation

Toshiharu Fujii1, Katsuaki Sakai1, Manabu Kimura1

  • 1Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.

European Heart Journal. Acute Cardiovascular Care
|February 17, 2016
PubMed

Insights

Patients with ST-elevation myocardial infarction and diffuse ectatic coronary arteries had lower initial blood flow success rates after percutaneous coronary intervention. However, coronary flow improved significantly by follow-up, with lower mortality rates observed in this group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • ST-elevation myocardial infarction (STEMI) with diffuse ectatic coronary arteries presents challenges for successful revascularization.
  • Extensive thrombi in these conditions often hinder achieving optimal Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow post-primary percutaneous coronary intervention (PCI).
  • Clinical and angiographic outcomes for STEMI patients with giant coronary artery ectasia remain uncertain.

Purpose of the Study:

  • To investigate the clinical and angiographic outcomes of STEMI patients with giant coronary artery ectasia.
  • To compare PCI success rates and long-term outcomes between patients with and without coronary artery ectasia.

Main Methods:

  • Retrospective analysis of 744 STEMI patients undergoing primary PCI.
  • Comparison of the Ectatic group (n=39) with the Non-ectatic group (n=705).
  • Assessment of PCI success rate, angiographic outcomes, and clinical outcomes at 360 days.

Main Results:

  • PCI success rate, defined by final TIMI grade 3 flow, was significantly lower in the Ectatic group (53.8%) compared to the Non-ectatic group (92.9% and 93.5%, p<0.0001).
  • Significant angiographic improvement to TIMI grade 3 flow was observed by follow-up in 86% of the Ectatic group, versus only 25% in the Non-ectatic group.
  • All-cause 360-day mortality was significantly lower in the Ectatic group (2.6%) than in the Non-ectatic group (14.5%, p=0.0361).

Conclusions:

  • STEMI patients with giant coronary artery ectasia experience reduced immediate TIMI grade 3 flow achievement post-PCI.
  • Coronary flow improvement to TIMI grade 3 is common at follow-up angiography in this patient cohort.
  • Despite lower initial procedural success, patients with diffuse ectatic coronary arteries in STEMI exhibit favorable long-term mortality outcomes.
Abstract

Keywords:
EctasiaST-elevation myocardial infarctionTIMI flowmortalitypercutaneous coronary intervention

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