Impact of post-dilatation on post-procedural physiology, microcirculatory resistance, and target vessel failure in STEMI patients undergoing PPCI: A single-center experience.

Abstract

BACKGROUND:

Suboptimal stent deployment is frequently observed in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). This study sought to investigate whether these patients could benefit from post-dilatation with respect to post-procedural physiology, microcirculatory resistance, and long-term clinical outcomes.

METHODS:

This was a retrospective study of consecutive STEMI patients who underwent successful stent implantation during PPCI from February 2016 to November 2021. Post-procedural physiology and microcirculatory resistance were assessed by Murray law-based quantitative flow ratio (μQFR) and angiographic microcirculatory resistance (AMR), respectively. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel-oriented myocardial infarction, and clinically driven target vessel revascularization.

RESULTS:

A total of 671 patients (671 culprit vessels) were included. Post-dilatation was selectively performed in 430 (64.1%) culprit vessels, resulting in a 0.02 (interquartile range: 0.00-0.05, p < 0.001) increase in post-procedural μQFR but no significant impact on AMR. During a median follow-up of 2.8 years (interquartile range: 1.4-3.0 years), TVF occurred in 47 (7.0%) patients. Post-dilatation demonstrated a trend toward a reduction in TVF (5.3% vs. 10.0%; adjusted hazard ratio: 0.60, 95% confidence interval: 0.33-1.09, p = 0.094), mainly driven by a lower incidence of clinically driven target vessel revascularization (1.6% vs. 4.1%; adjusted hazard ratio: 0.32, 95% confidence interval: 0.11-0.90, p = 0.030).

CONCLUSIONS:

In STEMI patients undergoing PPCI, selective post-dilatation was associated with improved post-procedural physiological results and a trend toward less TVF events without aggravating microcirculatory resistance.

• Authors: Mingfang Huang, Wei Chen, Donglin Liu, Min Zheng, Lirong Lin, Hui Jiang, Kaiyang Lin, Xi Zheng, Na Lin, Feng Lin, Xinjing Chen, Dusheng Zhang, Mingcheng Fang, Jingxuan Hong, Lihong Lu, Zhiyong Wu, Yansong Guo
• Journal: International journal of cardiology (Int J Cardiol) Vol. 399 Pg. 131685 (Mar 15 2024) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 38158133 (Publication Type: Journal Article)
• Copyright: Copyright © 2023. Published by Elsevier B.V.

Topics

• Humans
• ST Elevation Myocardial Infarction (diagnostic imaging, surgery)
• Treatment Outcome
• Microcirculation
• Retrospective Studies
• Dilatation
• Myocardial Infarction
• Percutaneous Coronary Intervention