Total ischemic time and age as predictors of PCI failure in STEMIs: A systematic review
Samantha R Kennedy1, Yunki Kim1, Scott Martin2
1Sacred Heart University, Fairfield, CT, USA.
Insights
Older patients and longer ischemic times increase the risk of coronary no-reflow after primary percutaneous coronary intervention (PCI). This phenomenon hinders cardiac tissue reperfusion, necessitating new guidelines and research for improved outcomes in ST-elevation myocardial infarction (STEMI) patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Infarction Research
Background:
- Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-elevation myocardial infarction (STEMI).
- Cardiac tissue reperfusion after primary PCI is not always achieved, leading to the "no-reflow" phenomenon.
- Factors influencing no-reflow, such as ischemic time and patient age, require systematic investigation.
Purpose of the Study:
- To systematically evaluate the predictive values of total ischemic time and patient age for coronary no-reflow.
- To assess the association between advanced age and prolonged ischemia with no-reflow post-primary PCI.
Main Methods:
- Systematic literature search across multiple databases (EBSCOhost, Cochrane).
- Screening, selection, and data extraction by two independent reviewers using Covidence.org.
- Quality assessment of eight selected cohort studies using the Newcastle-Ottawa Scale.
Main Results:
- The review included eight studies with 7060 participants.
- Patients over 60 years old had 1.53-2.53 times higher odds of experiencing no-reflow.
- Increased total ischemic time correlated with 1.147-4.655 times higher odds of no-reflow incidence.
Conclusions:
- Patients over 60 with ischemic times exceeding 4-6 hours face a heightened risk of PCI failure due to no-reflow.
- Improved coronary reperfusion after primary PCI requires novel guidelines and further research into preventing and treating no-reflow.
- Identifying high-risk patients can guide interventions to mitigate no-reflow complications.
Background:
When feasible, primary percutaneous coronary intervention (PCI) is the definitive intervention for ST-elevation myocardial infarction (STEMI). However, cardiac tissue reperfusion is not always achievable after opening the infarct-related artery. Studies have investigated associating factors and scoring for the "no-reflow" phenomenon. This paper aims to systematically establish the predictive values of total ischemic time and patient age as factors of coronary no-reflow in patients undergoing primary PCI.
Methods:
A systematic search was performed using EBSCOhost, including CINAHL Complete, Academic Search Premier, MEDLINE with Full Text, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Search results were compiled utilizing Zotero reference manager and exported to Covidence.org for screening, selection, and data extraction by two independent reviewers. The Newcastle-Ottawa Quality Assessment Scale for Cohort Studies was used to evaluate the eight selected studies.
Results:
The initial search resulted in 367 articles, with eight meeting the inclusion criteria with a total of 7060 participants. Our systematic review demonstrated that for patients older than 60 years, the odds of the no-reflow phenomenon increased 1.53- 2.53 times. Additionally, patients with increased total ischemic time had 1.147- 4.655 times the odds of no-reflow incidence.
Conclusions:
Patients older than 60 years with a total ischemic time >4-6 h are at higher risk of PCI failure due to the no-reflow phenomenon. Therefore, new guidelines and more research to prevent and treat this physiologic occurrence are essential to improve coronary reperfusion after primary PCI.
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