Abstract 11665: Increased Number of Repetitive Balloon Inflations in the Culprit Coronary Artery After Reperfusion During PCI is Associated with Favorable Clinical Outcomes in Patients with ST-Elevation Myocardial Infarction
Ischemic post-conditioning attenuates myocardial injury in acute myocardial infarction (AMI). Post-dilation of angioplasty balloon in the culprit coronary artery after reperfusion is required in the clinical setting of PCI. This study examined the hypothesis that the number of the post-dilation of the angioplasty balloon in the culprit artery during PCI may be related to clinical outcomes in patients with ST elevation myocardial infarction (STEMI), mimicking post-conditioning.
Methods and Results: This study included a total of 230 consecutive STEMI patients successfully treated with PCI. The number of the inflations of the angioplasty balloon in the culprit coronary artery after reperfusion during PCI was counted. After discharge, they were followed up for 4 years or until the occurrences of one of the following cardiac events: cardiac death, non fatal MI, unstable angina requiring revascularization, heart failure requiring hospitalization. During the follow up periods, cardiac events occurred in 69 patients (16 cardiac death, 13 non-fatal MI, 28 unstable angina, 12 heart failure). When outcomes stratified according to the number of the balloon inflations (≤2 times; n = 80, 3 - 4 times; n = 55, ≥5 times; n = 95), the rate of composite event of cardiac death and heart failure was decreased as the number of inflations was increased (<2, n=16 [20%]; 3 - 4; 8 [15%], >5; 4 [4%], p<0.01), while no differences in the rate of total cardiac events among the groups (p= 0.32). A subgroup of 93 patients had the repeated left ventriculography at discharge and 6 months after MI. Also, they had a test of endothelial vasomotor response of distal site of the culprit coronary artery to acetylcholine infusion (ACh, 50 μ g/min) at the discharge. Higher number of the balloon inflations attenuated the coronary constrictor response to ACh (%diameter change from baseline; <2, -65%; 3 - 4, -45%; >5, -10%, p < 0.05) and improved LVEF at 6 months (%change from LVEF at discharge; -4%, 2% and 5%, respectively, p < 0.01).
Conclusions: The increase in the number of the repetitive balloon inflations after reperfusion during PCI reduced endothelial injury of the culprit artery and restored LV function, which may lead to the favorable clinical outcomes, in STEMI patients successfully treated with PCI.
- © 2011 by American Heart Association, Inc.