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Suboptimal coronary blood flow after primary percutaneous coronary intervention for acute myocardial infarction: incidence, a simple risk score, and prognosis.
MedLine Citation:
PMID:  22318130     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: The aim of the present study is to investigate incidence, predictors, and long-term outcomes of suboptimal coronary flow after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in a large population.
METHODS: A total of 2056 consecutive patients with STEMI (mean age 56.2±11.7 years, 1738 men, 318 women) undergoing primary PCI were retrospectively enrolled in the present study. Patients were grouped as optimal [thrombolysis in myocardial infarction (TIMI) 3 flow, n=1939] and suboptimal (TIMI≤2 flow, n=117) according to the TIMI classification in the infarct-related artery at final coronary angiography after primary PCI, and were followed for in-hospital and long-term outcomes for a mean period of 1.9±1.3 years (median of 22 months).
RESULTS: Suboptimal coronary flow was observed in 5.7% (n=117) of the patients. Four variables, selected from the multivariate analysis, were weighted proportionally to their respective odds ratio for suboptimal coronary flow [predilatation before stenting (three points), Killip class 2/3 (two points), glomerular filtration rate<60 ml/min/1.73 m (two points), and anterior myocardial infarction (one point)]. Two strata of risk were defined (low risk, score 0-3; and high risk, score 4-8) and had a strong association with suboptimal coronary flow, and in-hospital and long-term cardiovascular mortalities. The suboptimal group had a higher prevalence of in-hospital mortality compared with the optimal group (22.2 vs. 1.2%, respectively, P<0.001). Long-term cardiovascular mortality was four-fold more in the suboptimal group than the optimal group (15.9 vs 3.7%, respectively, P<0.001).
CONCLUSION: Suboptimal coronary flow after primary PCI in STEMI is strongly related with increased in-hospital and long-term cardiovascular mortalities. Predilatation before stenting is the most powerful predictor of suboptimal coronary flow.
Huseyin Uyarel; Erkan Ayhan; Gokhan Cicek; Turgay Isik; Murat Ugur; Mehmet Bozbay; Ersin Yildirim; Mehmet Ergelen; Mehmet Eren
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Coronary artery disease     Volume:  23     ISSN:  1473-5830     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  98-104     Citation Subset:  IM    
aDepartment of Cardiology, Bezmialem Vakif University, School of Medicine bDepartment of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Training and Research Hospital, Istanbul cDepartment of Cardiology, Balikesir University, School of Medicine, Balikesir, Turkey.
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