Predictors of angiographically visible distal embolization in STEMI.
Prädiktoren der angiographisch sichtbaren distalen Embolie bei STEMI.
Acute myocardial infarction
Angiography
Distal embolization
ST-segment elevation myocardial infarction
Thrombectomy
Journal
Herz
ISSN: 1615-6692
Titre abrégé: Herz
Pays: Germany
ID NLM: 7801231
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
30
03
2018
accepted:
03
06
2018
revised:
06
05
2018
pubmed:
22
6
2018
medline:
1
7
2020
entrez:
22
6
2018
Statut:
ppublish
Résumé
Distal embolization during primary percutaneous coronary intervention (p-PCI) in the treatment of ST-segment elevation myocardial infarction (STEMI) is associated with a poor prognosis. In this situation, thrombectomy is performed to prevent distal embolization and to restore myocardial reperfusion. The aim of our study was to determine angiographic predictors of angiographically visible distal embolization (AVDE) in patients with STEMI treated by p‑PCI with thrombectomy. This prospective study included all consecutive patients who underwent p‑PCI with thrombectomy for STEMI at our institution between October 2011 and December 2014 AVDE was defined as a distal filling defect with an abrupt cut-off in one of the peripheral coronary branches of the infarct-related artery, distal to the angioplasty site. Thrombectomy was considered positive when it removed thrombi, and successful when it improved coronary flow. Among the 346 patients included, 59 (17%) developed AVDE during p‑PCI. In multivariate analysis, the infarct-related right coronary artery (OR: 2.48, 95% CI: 1.36-4.52; p = 0.003) and a culprit lesion diameter of >3 mm (OR : 1.90, 95% CI: 1.01-3.56; p = 0.048) were identified as independent factors associated with AVDE during p‑PCI with thrombectomy for STEMI. The success of thrombectomy and the Syntax score were not associated with AVDE. AVDE complicating p‑PCI with thrombectomy in STEMI is frequent (17%) and a successful thrombectomy does not rule out AVDE.
Sections du résumé
BACKGROUND
BACKGROUND
Distal embolization during primary percutaneous coronary intervention (p-PCI) in the treatment of ST-segment elevation myocardial infarction (STEMI) is associated with a poor prognosis. In this situation, thrombectomy is performed to prevent distal embolization and to restore myocardial reperfusion. The aim of our study was to determine angiographic predictors of angiographically visible distal embolization (AVDE) in patients with STEMI treated by p‑PCI with thrombectomy.
PATIENTS AND METHODS
METHODS
This prospective study included all consecutive patients who underwent p‑PCI with thrombectomy for STEMI at our institution between October 2011 and December 2014 AVDE was defined as a distal filling defect with an abrupt cut-off in one of the peripheral coronary branches of the infarct-related artery, distal to the angioplasty site. Thrombectomy was considered positive when it removed thrombi, and successful when it improved coronary flow.
RESULTS
RESULTS
Among the 346 patients included, 59 (17%) developed AVDE during p‑PCI. In multivariate analysis, the infarct-related right coronary artery (OR: 2.48, 95% CI: 1.36-4.52; p = 0.003) and a culprit lesion diameter of >3 mm (OR : 1.90, 95% CI: 1.01-3.56; p = 0.048) were identified as independent factors associated with AVDE during p‑PCI with thrombectomy for STEMI. The success of thrombectomy and the Syntax score were not associated with AVDE.
CONCLUSION
CONCLUSIONS
AVDE complicating p‑PCI with thrombectomy in STEMI is frequent (17%) and a successful thrombectomy does not rule out AVDE.
Identifiants
pubmed: 29926119
doi: 10.1007/s00059-018-4723-1
pii: 10.1007/s00059-018-4723-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM