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Changes of coronary blood flow before and after post-dilation following primary percutaneous coronary intervention in

Meng-Cheng Xu1, Maolin Zhao

  • 1Department of Cardiology, People's Hospital of Yingshan County, Huanggang, Hubei Province, People's Republic of China.

Medicine
|November 19, 2024
PubMed

Insights

Post-dilation during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction can worsen coronary blood flow and increase no-reflow/slow-flow events. However, this risk is reduced when after-stent corrected thrombolysis in myocardial infarction frame count is below 23.25.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • ST-segment elevation myocardial infarction (STEMI) requires prompt restoration of coronary blood flow.
  • Primary percutaneous coronary intervention (PPCI) is a key treatment for STEMI.
  • The role of post-dilation in optimizing outcomes after PPCI is debated, particularly regarding its impact on microvascular function.

Purpose of the Study:

  • To investigate the effect of post-dilation on coronary blood flow and microvascular complications after PPCI in STEMI patients.
  • To assess changes in corrected thrombolysis in myocardial infarction frame count (CTFC) and the incidence of no-reflow/slow-flow.
  • To identify predictors for adverse microvascular events following post-dilation.

Main Methods:

  • Retrospective cohort study of 419 STEMI patients undergoing PPCI.
  • Analysis of coronary blood flow using corrected thrombolysis in myocardial infarction frame count (CTFC) before and after post-dilation.
  • Assessment of final quantitative coronary angiography and incidence of no-reflow/slow-flow.
  • Comparison between patients who underwent post-dilation and those who did not.

Main Results:

  • Post-dilation was performed in 259 patients, often associated with calcified plaque, longer, larger, or overlapping stents.
  • Patients undergoing post-dilation showed significantly increased CTFC values (3.54 ± 10.54 frames, P < .001).
  • The incidence of no-reflow/slow-flow increased by 114% (P < .001) in the post-dilation group compared to the non-post-dilation group.
  • A post-dilation strategy was associated with a lower likelihood of no-reflow/slow-flow if after-stent CTFC was <23.25 (AUC: 0.817).

Conclusions:

  • Post-dilation in STEMI patients undergoing PPCI can exacerbate coronary blood flow impairment and increase no-reflow/slow-flow events.
  • The detrimental effect of post-dilation is mitigated when the after-stent CTFC is below 23.25.
  • Careful consideration of microvascular status, indicated by CTFC, is crucial when deciding on post-dilation during PPCI for STEMI.

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