Background
Methods
Study population
Study protocol
Clinical outcomes
Statistical analysis
Variables | Suboptimal flow (n = 245) | Optimal flow (n = 859) | P value |
---|---|---|---|
Mean age (yrs) | 62.9 ± 12.8 | 57.3 ± 12.3 | < 0.001 |
Females, n (%) | 58 (23.7) | 127 (14.8) | 0.002 |
Mean weight (kg) | 70.5 ± 11 | 72.1 ± 12 | 0.064 |
Hypertension, n (%) | 117 (47.8) | 390 (45.4) | 0.514 |
Diabetes, n (%) | 55 (22.4) | 161 (18.7) | 0.197 |
Smoking, n (%) | 114 (46.5) | 500 (58.2) | 0.001 |
Previous IHD, n (%) | 22 (9.0) | 72 (8.4) | 0.767 |
Previous CVS, n (%) | 15 (6.1) | 44 (5.1) | 0.539 |
Total ischemic time, hr. Median (IQR) | 4.5 (3–8) | 5 (3–8) | 0.341 |
Mean admission heart rate, bpm | 83.8 ± 13.2 | 82.5 ± 14.1 | 0.204 |
Mean systolic blood pressure, mm Hg | 127.5 ± 22.9 | 135.1 ± 21.3 | < 0.001 |
Mean diastolic blood pressure, mm Hg | 82.9 ± 12.8 | 87.5 ± 13.9 | < 0.001 |
Killip class > 1, n (%) | 80 (32.7) | 163 (19.0) | < 0.001 |
Cardiac arrest on presentation, n (%) | 17 (6.9) | 31 (3.6) | 0.024 |
Mean serum Creatinine, umol/L | 69.12 ± 20.04 | 65.79 ± 17.74 | 0.012 |
Triglyceride, mmol/L, Median (IQR) | 1.2 (0.9–1.9) | 1.4 (1.0–2.0) | 0.067 |
Mean HDL cholesterol, mmol/L | 1.01 ± 0.28 | 1.03 ± 0.27 | 0.133 |
Mean LDL cholesterol, mmol/L | 2.55 ± 0.99 | 2.64 ± 0.93 | 0.198 |
Mean Hemoglobin, g/L | 142.93 ± 18.4 | 147.09 ± 17.18 | 0.001 |
Mean Platelets count, (×109/L) | 213.26 ± 63.53 | 215.3 ± 65.75 | 0.665 |
Mean White blood cells count, (× 109/L) | 11.36 ± 3.90 | 11.09 ± 3.94 | 0.359 |
TNT-hs, ng/mL, Median (IQR) | 0.4 (0.09–1.5) | 0.4 (0.09–1.2) | 0.695 |
Admission CK-MB, U/L, Median (IQR) | 42.0 (24.0–134.5) | 53(23.0–116.0) | 0.992 |
NT-ProBNP, pg/mL, Median (IQR) | 223 (93.0–743.5) | 264 (89.0–735.3) | 0.774 |
hsCRP, mg/L, Median (IQR) | 3 (1.25–7.3) | 2.6 (1.0–6.2) | 0.063 |
Mean HemoglobinA1c% | 6.24 ± 1.47 | 6.09 ± 1.35 | 0.119 |
Variables | Suboptimal flow (n = 245) | Optimal flow (n = 859) | P value |
---|---|---|---|
Left main involvement, n (%) | 29 (11.8) | 72 (8.4) | 0.098 |
Number of diseased vessels, n (%) | |||
One | 73 (29.8) | 263 (30.6) | |
Two | 97 (39.6) | 309 (36.0) | 0.555 |
Three | 75 (30.6) | 287 (33.4) | |
LAD lesion location, n (%) | |||
Proximal | 194 (79.2) | 624 (72.6) | |
Mid | 47 (19.2) | 226 (26.3) | 0.062 |
Distal | 4 (1.6) | 9 (1.0) | |
Thrombus burden grade 4, n (%) | 79 (32.2) | 123 (14.3) | < 0.001 |
Moderate/severe calcification, n (%) | 28 (11.4) | 85 (9.9) | 0.485 |
Initial TIMI ≤1, n (%) | 208 (84.9) | 572 (66.6) | < 0.001 |
Approach, n (%) | |||
Radial | 232 (94.7) | 825 (96.0) | 0.357 |
Femoral | 13 (5.3) | 34 (4.0) | |
Stents, n (%) | |||
PTCA | 3 (1.2) | 23 (2.7) | |
One | 135 (55.1) | 555 (64.6) | 0.006 |
Two | 98 (40.0) | 266 (31.0) | |
Three | 9 (3.7) | 15 (1.7) | |
Total Stent length, mm | 40.7 ± 17.2 | 35.7 ± 14.2 | < 0.001 |
Mean stent diameter, mm | 3.02 ± 0.5 | 2.94 ± 0.6 | 0.067 |
Bifurcation stenting, n (%) | 2 (0.8) | 3 (0.3) | 0.337 |
P2Y12 inhibitor, n (%) | |||
Clopidogrel | 180 (73.5) | 607 (70.7) | 0.392 |
Ticagrelor | 65 (26.5) | 252 (29.3) | |
Thrombus Aspiration, n (%) | 78 (31.8) | 193 (22.5) | 0.003 |
IABP, n (%) | 37 (15.1) | 63 (7.3) | < 0.001 |
Results
Clinical characteristics
Angiographic data and primary PCI procedure
Variables | Total population | Propensity-matched population | ||||
---|---|---|---|---|---|---|
Suboptimal flow (n = 245) | Optimal flow (n = 859) | P value | Suboptimal flow (n = 214) | Optimal flow (n = 214) | P value | |
Medications used during primary PCI | ||||||
Glycoprotein IIb/IIIa inhibitor, n (%) | 65 (26.5) | 99 (11.5) | < 0.001 | 56 (26.2) | 40 (18.7) | 0.098 |
IC Nitroprusside, n (%) | 37 (15.1) | 56 (6.5) | < 0.001 | 35 (16.4) | 5 (2.3) | < 0.001 |
IC Adrenaline, n (%) | 23 (9.4) | 28 (3.3) | < 0.001 | 18 (8.4) | 11 (5.1) | 0.178 |
Atropine, n (%) | 27 (11.0) | 72 (8.4) | 0.202 | 22 (10.3) | 26 (12.1) | 0.643 |
Noradrenaline, n (%) | 106 (43.3) | 128 (14.9) | < 0.001 | 91 (42.5) | 35 (16.4) | < 0.001 |
Post-procedural clinical parameters | ||||||
Creatine kinase peak, U/L, Median (IQR) | 5268 (3829.0–7422.0) | 4215 (2300.0–6409.0) | < 0.001 | 5265 (3829.0–7422.0) | 4542 (2156.3–6740.5) | 0.002 |
ST segment resolution, n (%) | ||||||
< 70% | 109 (44.5) | 315 (36.7) | 0.026 | 97 (45.3) | 80 (37.4) | 0.108 |
> 70% | 136 (55.5) | 544 (63.3) | 117 (54.7) | 134 (62.6) | ||
Mean Ejection Fraction (%) | 43.8 ± 6.2 | 46.2 ± 6.9 | < 0.001 | 43.71 ± 6.41 | 45.34 ± 7.48 | 0.015 |
Hospital stay (days), Median (IQR) | 4 (3–6) | 4 (3–5) | < 0.001 | 4 (3–6) | 4 (3–6) | 0.864 |
Baseline clinical and angiographic characteristics of the PS-matched population
Variables | Suboptimal flow (n = 214) | Optimal flow (n = 214) | P value |
---|---|---|---|
Mean age (yrs) | 61.75 ± 12.8 | 63.60 ± 12.6 | 0.131 |
Females, n (%) | 48 (22.4) | 58 (27.6) | 0.229 |
Mean weight (kg) | 70.50 ± 12.20 | 68.72 ± 11.7 | 0.127 |
Hypertension, n (%) | 103 (48.1) | 114 (53.3) | 0.338 |
Diabetes, n (%) | 43 (20.1) | 40 (18.7) | 0.801 |
Smoking, n (%) | 102 (47.7) | 106(49.5) | 0.769 |
Previous IHD, n (%) | 20 (9.3) | 30 (14) | 0.175 |
Previous CVS, n (%) | 14 (6.5) | 16 (7.5) | 0.855 |
Total ischemic time, hr. Median (IQR) | 5 (3–8) | 4 (3–7) | 0.548 |
Mean admission heart rate, bpm | 83.96 ± 13.3 | 82.44 ± 14.8 | 0.252 |
Mean systolic blood pressure, mm Hg | 129.17 ± 22.6 | 131.54 ± 21.5 | 0.232 |
Mean diastolic blood pressure, mm Hg | 83.57 ± 12.9 | 83.85 ± 13.2 | 0.82 |
Killip class > 1, n (%) | 66 (30.8) | 57 (26.6) | 0.380 |
Cardiac arrest on presentation, n (%) | 12 (5.6) | 13 (6.1) | 0.837 |
Mean serum Creatinine, umol/L | 68.56 ± 19.5 | 67.81 ± 19.1 | 0.68 |
Triglyceride, mmol/L, Median (IQR) | 1.27 (0.93–1.9) | 1.20 (0.90–1.9) | 0.622 |
Mean HDL cholesterol, mmol/L | 1.01 ± 0.28 | 0.97 ± 0.29 | 0.170 |
Mean LDL cholesterol, mmol/L | 2.60 ± 1.02 | 2.46 ± 0.91 | 0.122 |
Mean Hemoglobin, g/L | 144.29 ± 18.07 | 142.06 ± 18.35 | 0.171 |
Mean Platelets count, (×109/L) | 213.68 ± 60.59 | 214.96 ± 70.24 | 0.840 |
Mean White blood cells count, (×109/L) | 11.30 ± 3.92 | 11.46 ± 4.24 | 0.690 |
TNT-hs, ng/mL, Median (IQR) | 0.4 (0.1–1.5) | 0.33 (0.08–1.085) | 0.150 |
Admission CK-MB, U/L, Median (IQR) | 41.5 (25.75–131.5) | 48.0(21–102.5) | 0.492 |
NT-ProBNP, pg/mL, Median (IQR) | 223 (93.75–722.5) | 250 (90.75–847.5) | 0.061 |
hsCRP, mg/L, Median (IQR) | 2.9 (1.2–6.88) | 3.3 (1.1–8.5) | 0.396 |
Mean HemoglobinA1c % | 6.11 ± 1.31 | 5.99 ± 1.1 | 0.270 |
Variables | Suboptimal flow (n = 214) | Optimal flow (n = 214) | P value |
---|---|---|---|
Left main involvement, n (%) | 24 (11.2) | 15 (7) | 0.188 |
Number of diseased vessels, n (%) | |||
One | 68 (31.8) | 73 (34.1) | |
Two | 79 (36.9) | 71 (33.2) | 0.865 |
Three | 67 (31.3) | 70 (32.7) | |
LAD lesion location, n (%) | |||
Proximal | 166 (77.6) | 178 (83.2) | |
Mid | 44 (20.6) | 36 (16.8) | 0.082 |
Distal | 4 (1.9) | 0 (0) | |
Thrombus burden grade 4, n (%) | 60 (28) | 60 (28) | 1.0 |
Moderate/severe calcification, n (%) | 22 (10.3) | 33 (15.4) | 0.161 |
Initial TIMI ≤1, n (%) | 178 (83.2) | 165 (77.1) | 0.118 |
Approach, n (%) | |||
Radial | 207 (96.7) | 203 (94.9) | 0.335 |
Femoral | 7 (3.3) | 11 (5.1) | |
Stents, n (%) | |||
PTCA | 0 (0) | 0 (0) | |
One | 123 (57.5) | 133 (62.1) | 0.241 |
Two | 83 (38.8) | 76 (35.5) | |
Three | 8 (3.7) | 5 (2.3) | |
Total Stent length, mm | 39.99 ± 17.28 | 37.53 ± 14.97 | 0.106 |
Mean stent diameter, mm | 3.03 ± 0.36 | 3.06 ± 0.37 | 0.512 |
Bifurcation stenting, n (%) | 2 (0.9) | 2 (0.9) | 1.0 |
P2Y12 inhibitor, n (%) | |||
Clopidogrel | 154 (72.0) | 153 (71.5) | 0.915 |
Ticagrelor | 60 (28.0) | 61 (28.5) | |
Thrombus Aspiration, n (%) | 64 (29.9) | 77 (36.0) | 0.208 |
IABP, n (%) | 24 (11.2) | 20 (9.3) | 0.635 |
Independent predictors of suboptimal flow
Variables | OR | 95% CI for OR | P value |
---|---|---|---|
Thrombus burden, grade | 1.848 | 1.532–2.229 | < 0.001 |
Age, per 1-year increase | 1. 039 | 1.026–1.052 | < 0.001 |
Systolic blood pressure, per 1 mmHg decrease | 1.017 | 1.009–1.025 | < 0.001 |
Total stent length, per 1 mm increase | 1.021 | 1.011–1.032 | < 0.001 |
Baseline TIMI flow ≤1 | 1.674 | 1.094–2.562 | 0.018 |
30-day clinical outcomes
Variables | Total population | Propensity-matched population | ||||||
---|---|---|---|---|---|---|---|---|
Suboptimal flow (n = 245) | Optimal flow (n = 859) | Unadjusted RR (95% CI) | P value | Suboptimal flow (n = 214) | Optimal flow (n = 214) | Adjusted RR (95% CI) | P value | |
MACE, n (%) | 34 (13.9) | 52 (6.1) | 2.416 (1.522–3.833) | < 0.001 | 29 (13.6) | 14 (6.5) | 2.021 (1.097–3.535) | 0.025 |
Mortality (cardiac), n (%) | 18 (7.3) | 19 (2.2) | 3.506 (1.810–6.790) | < 0.001 | 15 (7.0) | 5 (2.3) | 2.931 (1.073–7.442) | 0.031 |
Re-infarction, n (%) | 18 (7.3) | 30 (3.5) | 2.118 (1.163–3.856) | 0.014 | 17 (7.9) | 8 (3.7) | 2.060 (0.905–4.438) | 0.108 |
Revascularization, n (%) | 15 (6.1) | 28 (3.3) | 1.936 (1.017–3.685) | 0.044 | 14 (6.5) | 6 (2.8) | 2.271 (0.889–5.465) | 0.115 |
Ischemic stroke, n (%) | 1 (0.4) | 3 (0.3) | 1.169 (0.122–11.185) | 0.892 | 1 (0.5) | 0 (0) | NA | 0.995 |
Cardiogenic shock, n (%) | 33 (13.5) | 45 (5.2) | 2.829 (1.761–4.545) | < 0.001 | 25 (11.7) | 12 (5.6) | 2.061 (1.040–3.852) | 0.039 |
Heart Failure, n (%) | 84 (34.3) | 164 (19.1) | 2.211 (1.615–3.026) | < 0.001 | 69 (32.2) | 48 (22.4) | 1.412 (1.024–1.866) | 0.036 |
Malignant arrhythmias, n (%) | 42 (17.1) | 88 (10.2) | 1.813 (1.217–2.701) | 0.003 | 37 (17.3) | 20 (9.3) | 1.850 (1.119–2.914) | 0.017 |
Bradyarrhythmias, n (%) | 27 (11.0) | 65 (7.6) | 1.513 (0.943–2.428) | 0.084 | 22 (10.3) | 19 (8.9) | 1.143 (0.629–1.997) | 0.655 |
Bleeding, n (%) | 14 (5.7) | 34 (4.0) | 1.471 (0.776–2.787) | 0.237 | 10 (4.7) | 7 (3.3) | 1.360 (0.517–3.417) | 0.529 |