医学
四分位间距
罪魁祸首
心脏病学
危险系数
经皮冠状动脉介入治疗
内科学
心肌梗塞
部分流量储备
血运重建
置信区间
冠状动脉造影
作者
Mingfang Huang,Wei Chen,Donglin Liu,Minjuan Zheng,Lin Li,Hui Jiang,Kaiyang Lin,Xiaojiao Zheng,Na Lin,Feng Lin,Xinjing Chen,Danwei Zhang,Mingcheng Fang,Jing Hong,Lihong Lu,Zhiyong Wu,Yansong Guo
标识
DOI:10.1016/j.ijcard.2023.131685
摘要
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 is 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.
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