Abstract
Aim. To assess whether delayed coronary artery stenting (CAS) can reduce the slow/no-reflow incidence in patients with ST-segment elevation myocardial infarction (STEMI) and massive thrombosis (TTG ≥3) of the infarct-related coronary artery (IRCA) compared with immediate CAS within primary PCI.Material and methods. Out of 3651 primary PCIs performed for acute STEMI in the period from January 2016 to May 2020 at the Mytishchi City Clinical Hospital, the retrospective analysis included 105 patients with massive IRCA thrombosis (TTG ≥3). The patients were divided into two groups: first group (n=55) — delayed CAS, second group (n=50) — immediate CAS. In the immediate CAS group, the PCI procedure ended with routine stent implantation, and in the delayed CAS group, stent implantation was delayed for at least 5 days.Results. In the delayed CAS group in comparison with immediate one, the slow/no-reflow phenomenon developed much less frequently in the form of a significant increase in the prevalence of TIMI 3 flow, better myocardial perfusion of myocardial blush grade (MBG) 2-3 (81,8 vs 64%; odds ratio (OR) 2,53; p=0,039) and ST segment resolution ≥70% (87,3% vs 58%; OR 4,97; p=0,001).Conclusion. Delayed CAS in patients with STEMI with massive thrombosis (TTG ≥3) of IRCA reduces the risk of slow/no-reflow phenomenon and can be considered as a possible alternative treatment vs immediate CAS, provided that stable coronary flow is restored before TIMI 3.
Highlights
В группе отсроченное стентирование коронарной артерии (ОСКА) в сравнении с немедленным стентированием коронарной артерии (НСКА) развитие феномена “slow/no-reflow” имело место значительно реже в виде статистически значимого увеличения частоты встречаемости кровотока TIMI 3, показателя тканевой миокардиальной перфузии myocardial blush grade (MBG) 2-3 (81,8 vs 64%; отношение шансов 2,53; p=0,039) и резолюции сегмента ST ≥70% на электрокардиограмме (87,3% vs 58%; отношение шансов 4,97; p=0,001)
Out of 3651 primary PCIs performed for acute segment elevation myocardial infarction (STEMI) in the period from January 2016 to May 2020 at the Mytishchi City Clinical Hospital, the retrospective analysis included 105 patients with massive infarct-related coronary artery (IRCA) thrombosis (TTG ≥3)
The patients were divided into two groups: first group (n=55) — delayed coronary artery stenting (CAS)
Summary
Out of 3651 primary PCIs performed for acute STEMI in the period from January 2016 to May 2020 at the Mytishchi City Clinical Hospital, the retrospective analysis included 105 patients with massive IRCA thrombosis (TTG ≥3). П. — д.м.н., профессор кафедры интервенционной кардиоангиологии ИПО, директор НПЦИК (Сеченовский университет), ORCID: 0000-0002-1268-5145, Журавлев А. Х. — аспирант кафедры интервенционной кардиоангиологии ИПО, ORCID: 0000-0002-8148-6510, Мельниченко И. А. — к.м.н., ассистент кафедры интервенционной кардио ангиологии ИПО, врач по РЭДЛ НПЦИК (Сеченовский университет), ORCID: 0000-0002-6834-6150]. Delayed CAS in patients with STEMI with massive thrombosis (TTG ≥3) of IRCA reduces the risk of slow/no-reflow phenomenon and can be considered as a possible alternative treatment vs immediate CAS, provided that stable coronary flow is restored before TIMI 3. A. Delayed endovascular surgery in patients with acute ST-segment elevation myocardial infarction due to massive culprit arterial thrombosis in the prevention of slow/no-reflow phenomenon. Может ли отсроченное стентирование коронарной артерии (ОСКА) уменьшить частоту развития феномена “slow/no-ref low” у пациентов с ИМ↑ST с массивным тромбозом (TTG ≥3) ИОКА по сравнению с НСКА при первичном ЧКВ
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