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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Acute Heart Failure and Coronary Blood Flow in ST-Elevation Myocardial Infarction Patients Undergoing Primary
Amr Elkammash1, Mohamed Abdelhamid2, Mohamed Sobhy2
1Cardiology, Bristol Heart Institute, Bristol, GBR.
Insights
Acute heart failure (AHF) in ST-elevation myocardial infarction (STEMI) patients increases the risk of no-reflow after primary percutaneous coronary intervention (PPCI). This occurs independently of coronary thrombus burden, highlighting AHF as a critical factor in STEMI outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Heart Failure
Background:
- Acute heart failure (AHF) is linked to poor outcomes in ST-elevation myocardial infarction (STEMI) patients.
- Previous studies, like the GRACE registry, indicate higher mortality and readmission rates for STEMI patients with AHF.
Purpose of the Study:
- To investigate the impact of AHF on coronary thrombus burden and post-primary percutaneous coronary intervention (PPCI) coronary flow in STEMI patients.
- To determine if AHF is an independent predictor of adverse coronary flow outcomes after PPCI.
Main Methods:
- A cohort study of 210 STEMI patients undergoing PPCI.
- Patients were stratified into no heart failure (NHF) and AHF groups based on Killip class.
- Primary outcome: no-reflow (TIMI flow <3); Secondary outcome: heavy thrombus burden (TIMI grade 4 or 5).
Main Results:
- The AHF group exhibited a significantly higher incidence of no-reflow post-PPCI compared to the NHF group (25% vs. 8.4%, p=0.019).
- No significant difference in heavy thrombus burden was observed between the AHF and NHF groups (50% vs. 43.16%, p=0.557).
- Multivariable analysis identified AHF as an independent predictor of no-reflow (OR: 3.59, 95% CI: 1.09-11.83, p=0.035).
Conclusions:
- AHF at admission is associated with an increased risk of no-reflow following PPCI in STEMI patients.
- This association persists regardless of the initial coronary thrombus load.
- AHF is a significant independent predictor of impaired coronary flow post-PPCI in STEMI.
Abstract:
Background and objective The Global Registry of Acute Coronary Events (GRACE) study showed poor outcomes in ST-elevation myocardial infarction (STEMI) patients with acute heart failure (AHF) at hospital admission in terms of increased in-hospital and six-month mortality and readmission rates. In this study, we aimed to examine the effects of AHF at the time of admission on the coronary thrombus burden and post-primary percutaneous coronary intervention (PPCI) coronary flow among STEMI patients. Methods We conducted a cohort study involving 210 consecutive STEMI patients who presented to a single PPCI centre between June 2016 and January 2017. We classified them into two groups based on their Killip class at the time of presentation to the emergency department: no heart failure (NHF) and AHF groups. The primary outcome was the incidence of Thrombolysis In Myocardial Infarction (TIMI) flow grade of less than 3 in the stented coronary artery in the absence of mechanical obstruction or dissection (also known as no-reflow). The secondary outcome was the presence of a heavy thrombus burden (TIMI grade 4 or 5) at the time of angiography. Results The AHF group had a significantly higher incidence of no-reflow than the NHF group (25% vs. 8.4%, p=0.019). However, the prevalence of heavy thrombus burden did not differ significantly between the two groups (50% in the AHF group vs. 43.16% in the NHF group, p=0.557). The multivariable logistic regression analysis showed that AHF was an independent predictor of no-reflow in STEMI patients post-PPCI [Odds ratio (OR): 3.59, 95% confidence interval (CI): 1.09-11.83, p=0.035]. Conclusion Based on our findings, AHF is associated with an increased risk of no-reflow in STEMI patients post-PPCI, irrespective of the coronary thrombus load.
