Abstract 3666: Predicting Worse Reperfusion on Myocardial Level Based on Angiographic Morphologic Features of Target Lesions in Acute St-elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention
Objective To explore the angiographic morphologic features of worse reperfusion state on myocardial level in ST-Elevation Myocardial Infarction after primary percutaneous coronary intervention.
Methods A formal ST-segment analysis was performed in 964 patients undergoing primary PCI for STEMI. The predictive factors of worse reperfusion state on myocardial level were selected by statistic software.
Results The incidence of worse reperfusion on myocardial level was significantly higher in patients with vs. those without the following prerevascularization angiographic morphologic features: fade-out type, ie, accumulated thrombus proximal to the occlusion (OR=4.78, P<0.001), reference lumen diameter (RLD) of the IRA >or =4 mm (OR=1.77, P=0.17), presence of floating thrombus (OR=1.19, P=0.71), and persistent dye stasis distal to the obstruction (OR=1.16, P=0.64). Multiple analysis demonstrated that fade-out type was the independent predictor of worse reperfusion. In addition, cardiac dysfunction (Killip >or =II, OR=3.57, P=0.002), and time of pain to balloon (OR=1.22, P=0.002) were independent clinical predictors of worse reperfusion. The inhospital and follow-up mortality were higher in worse reperfusion group than in good reperfusion group (34.3% vs. 1.1%, P<0.001; and 61.9% vs. 5.0%, P<0.001).
Conclusions The specific clinical and angiographic morphologic features in the IRAs can be used as a simple and efficacious method to predict worse reperfusion state on myocardial level in ST-Elevation Myocardial Infarction after primary percutaneous coronary intervention.