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Published on: January 28, 2020
Influence of angiographic spontaneous coronary reperfusion on long-term prognosis in patients with ST-segment
Xiaoming Li1, Boyu Li1, Jing Gao1
1Division of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China.
Insights
Spontaneous coronary reperfusion (SR) in ST-segment elevation myocardial infarction (STEMI) patients significantly improves short-term outcomes. Long-term results were comparable between groups, highlighting SR
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt reperfusion.
- Spontaneous coronary reperfusion (SR) during angiography may influence patient outcomes.
- Understanding SR's impact is vital for optimizing STEMI management.
Purpose of the Study:
- To investigate the association between angiographic spontaneous coronary reperfusion (SR) and patient outcomes following STEMI.
- To compare short-term and long-term clinical results in STEMI patients with and without SR.
Main Methods:
- A cohort of 207 STEMI patients undergoing emergent coronary angiography was analyzed.
- Patients with initial Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow were classified as SR.
- The remaining patients (TIMI grade < 3) formed the non-spontaneous reperfusion (NSR) group, undergoing primary percutaneous coronary intervention (PCI).
Main Results:
- The SR group (n=38) exhibited younger age, higher smoking rates, and distinct metabolic profiles compared to the NSR group (n=169).
- SR patients had significantly lower in-hospital events (0% vs. 22.5%, p < 0.001) and required fewer stents.
- Long-term outcomes at 41-month follow-up were similar between SR and NSR groups (2.6% vs. 6.9%, p = 0.302).
Conclusions:
- Angiographic spontaneous coronary reperfusion (SR) is linked to markedly better short-term outcomes in STEMI patients.
- SR appears to be a favorable prognostic marker in the acute phase of STEMI.
- While SR improves immediate results, long-term prognosis may be less influenced by initial reperfusion status.
Objective:
To explore the influence of angiographic spontaneous coronary reperfusion (SR) on the short- and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI).
Materials And Methods:
Consecutive patients diagnosed as STEMI and undergoing emergent coronary angiography from January 2009 to August 2010 in a single center were enrolled. Patients whose initial coronary blood flow met Thrombolysis in Myocardial Infarction (TIMI) grade 3 were regarded as angiographic SR. Others (TIMI grade < 3) were included into the NSR group and subsequently underwent primary percutaneous coronary intervention (PCI). Patients' characteristics and outcomes were compared.
Results:
A total of 207 patients were eligible for analysis. The coincidence rate of patients both with ≥ 70% ST-segment resolution and ≥ 70% relief of chest pain and SR was 100%. Patients in the SR group (n = 38) were younger, had more smokers, with higher level of platelet count, lower blood glucose and uric acid, and more distal culprit lesions, as compared to the NSR group (n = 169). Importantly, patients in the SR group had lower rates of in-hospital events (0 vs. 22.5%, p < 0.001) with less stents placed (1.03 ± 1.05 vs. 1.59 ± 1.17, p = 0.007). Moreover, there were comparable long-term outcomes (2.6% vs. 6.9%, p = 0.302) between the two groups during 41-month follow ups.
Conclusions:
Angiographic SR is associated with significantly favorable short-term outcomes.
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