Abstract
BackgroundThe management of diagonal branch (D) occlusion is still controversary. The association between the flow loss of D and the prognosis remains unclear. We aim to detect the impact of D flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI).MethodsPatients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI) at our clinic between October 2015 and October 2018were reviewed. Anterior STEMI due to left anterior descending artery (LAD) occlusion with or without loss of the main D flow (TIMI grade 0–1 or 2–3) was enrolled in the analysis. The short- and long-term incidence of major adverse cardiac events (MACEs, a composite of all-cause death, target vessel revascularization and reinfarction) and left ventricular ejection fraction (LVEF) were analyzed.ResultsA total of 392 patients (mean age of 63.9 years) with anterior STEMI treated with primary PCI was enrolled in the study. They were divided into two groups, loss (TIMI grade 0–1, n = 69) and no loss (TIMI grade2–3, n = 323) of D flow, before primary PCI. Compared with the group without loss of D flow, the group with loss of D flow showed a lower LVEF post PCI (41.0% vs. 48.8%, p = 0.003). Meanwhile, loss of D flow resulted in the higher in-hospital, one-month, and 18-month incidence of MACEs, especially in all-cause mortality (all p < 0.05). Landmark analysis further indicated that the significant differences in 18-month outcomes between the two groups mainly resulted from the differences during the hospitalization. In addition, multivariate Cox proportional hazards analysis found that D flow loss before primary PCI was independent factor predicting short- and long-term outcomes in patients with anterior STEMI.ConclusionLoss of the main D flow in anterior STEMI patients was independently associated with the higher in-hospital incidences of MACEs and all-cause death as well as the lower LVEF.
Highlights
ST-segment elevation myocardial infarction (STEMI),especially anterior STEMI, is the most severe type of coronary artery disease, with potential for substantialZhang et al BMC Cardiovascular Disorders (2020) 20:108 contrast, isolated occlusion of the D is relatively rare for anterior STEMI and has little effect on cardiac function [5]; percutaneous coronary intervention (PCI) of the D as a non-culprit vessel fails to reduce the rate of adverse clinical outcomes [6, 7]
Zhang et al BMC Cardiovascular Disorders (2020) 20:108 contrast, isolated occlusion of the D is relatively rare for anterior STEMI and has little effect on cardiac function [5]; PCI of the D as a non-culprit vessel fails to reduce the rate of adverse clinical outcomes [6, 7]
It remains unclear whether the Thrombolysis in Myocardial Infarction (TIMI) flow loss of the main D of left anterior descending artery (LAD) would lead to the worse clinical outcomes in patients with anterior STEMI
Summary
ST-segment elevation myocardial infarction (STEMI),especially anterior STEMI, is the most severe type of coronary artery disease, with potential for substantialZhang et al BMC Cardiovascular Disorders (2020) 20:108 contrast, isolated occlusion of the D is relatively rare for anterior STEMI and has little effect on cardiac function [5]; PCI of the D as a non-culprit vessel fails to reduce the rate of adverse clinical outcomes [6, 7]. In the scant literature available, the loss of D flow appears associated with more severe myocardial ischemia and the higher incidence of major adverse cardiac events (MACEs). It remains unclear whether the TIMI flow loss of the main D of LAD would lead to the worse clinical outcomes in patients with anterior STEMI. The present study aimed to detect the association between the baseline TIMI flow of D and cardiac function as well as outcomes of anterior STEMI subjects following primary PCI. We aim to detect the impact of D flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI)
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