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Published on: April 25, 2014
The diagonal branches and outcomes in patients with anterior ST- elevation myocardial infarction
Shuning Zhang1,2, Xin Deng1,2, Wenlong Yang1,2
1Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Insights
Loss of diagonal branch flow in anterior ST-segment elevation myocardial infarction (STEMI) patients is linked to worse cardiac function and higher mortality. This finding highlights the importance of preserving D flow during primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Infarction Research
Background:
- Management of diagonal branch (D) occlusion in anterior ST-elevation myocardial infarction (STEMI) remains controversial.
- The prognostic impact of D artery flow loss in STEMI patients is not well-defined.
- Assessing D flow's effect on cardiac function and clinical outcomes in anterior STEMI is crucial.
Purpose of the Study:
- To determine the impact of D artery flow on cardiac function (left ventricular ejection fraction) in anterior STEMI patients.
- To evaluate the association between D artery flow status and short- and long-term clinical outcomes, including major adverse cardiac events (MACEs).
- To identify D flow loss as a potential independent predictor of outcomes in anterior STEMI.
Main Methods:
- Retrospective review of 392 anterior STEMI patients undergoing primary percutaneous coronary intervention (PCI).
- Patients were categorized based on D artery flow: loss (TIMI grade 0-1) versus no loss (TIMI grade 2-3) before PCI.
- Analysis included assessment of left ventricular ejection fraction (LVEF) and incidence of MACEs (all-cause death, target vessel revascularization, reinfarction) at various time points.
Main Results:
- Patients with D flow loss exhibited significantly lower LVEF post-PCI compared to those with preserved flow (41.0% vs. 48.8%, p=0.003).
- D flow loss was associated with higher in-hospital, one-month, and 18-month MACE rates, particularly all-cause mortality (p < 0.05 for all).
- Multivariate analysis identified D flow loss as an independent predictor of both short- and long-term adverse outcomes in anterior STEMI.
Conclusions:
- Loss of main D artery flow in anterior STEMI is independently associated with impaired left ventricular ejection fraction.
- D flow loss significantly increases the risk of in-hospital major adverse cardiac events and all-cause death.
- Preserving D artery flow during primary PCI is critical for improving cardiac function and patient prognosis in anterior STEMI.
Background:
The management of diagonal branch (D) occlusion is still controversary. The association between the flow loss of D and the prognosis remains unclear. We aim to detect the impact of D flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI).
Methods:
Patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI) at our clinic between October 2015 and October 2018were reviewed. Anterior STEMI due to left anterior descending artery (LAD) occlusion with or without loss of the main D flow (TIMI grade 0-1 or 2-3) was enrolled in the analysis. The short- and long-term incidence of major adverse cardiac events (MACEs, a composite of all-cause death, target vessel revascularization and reinfarction) and left ventricular ejection fraction (LVEF) were analyzed.
Results:
A total of 392 patients (mean age of 63.9 years) with anterior STEMI treated with primary PCI was enrolled in the study. They were divided into two groups, loss (TIMI grade 0-1, n = 69) and no loss (TIMI grade2-3, n = 323) of D flow, before primary PCI. Compared with the group without loss of D flow, the group with loss of D flow showed a lower LVEF post PCI (41.0% vs. 48.8%, p = 0.003). Meanwhile, loss of D flow resulted in the higher in-hospital, one-month, and 18-month incidence of MACEs, especially in all-cause mortality (all p < 0.05). Landmark analysis further indicated that the significant differences in 18-month outcomes between the two groups mainly resulted from the differences during the hospitalization. In addition, multivariate Cox proportional hazards analysis found that D flow loss before primary PCI was independent factor predicting short- and long-term outcomes in patients with anterior STEMI.
Conclusion:
Loss of the main D flow in anterior STEMI patients was independently associated with the higher in-hospital incidences of MACEs and all-cause death as well as the lower LVEF.
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