Shaaban Raouf, El Etriby Adel, Kamal Diaa, Mostafa Ahmad E
Cardiology Department, Ain Shams University, 38 Ramsis Street, El Abbaseya, Cairo, Egypt.
Egypt Heart J. 2022 Jun 27;74(1):52. doi: 10.1186/s43044-022-00289-3.
Primary percutaneous coronary intervention (PCI) is considered the most preferred strategy in ST-segment elevation myocardial infarction (STEMI). However, the prognostic role of spontaneous re-canalization in STEMI patients is still not clear. The purpose of this study is to evaluate the impact of pre-procedural TIMI flow grade in the culprit coronary artery on the short and long term prognosis in Egyptian patients presented with STEMI and treated with primary PCI.
A dual center, prospective observational study that was conducted in the period from January 2019 till June 2020 and enrolled 150 STEMI patients presented within 24 h from onset of chest pain. Initial angiography was done with analysis of TIMI flow grade in the infarct related artery. Of the 150 enrolled patients; 93 patients (62%) were found to have initial TIMI flow grade 0 (group A) and 57 patients (38%) had initial TIMI flow grade I-III (group B). There was a strong association between cardiac mortality and pre-procedural TIMI flow grade. 12 mortalities (8% of total study population) were recorded during our study period; in-hospital mortality was reported in 7 patients in group A, yet no mortalities were recorded in-hospital in group B (P value = 0.033). At 1 year follow up; 5 mortalities were recorded in group A with no mortalities at all in group B (P value = 0.005). There was a trend towards an increase in acute heart failure incidence in group A yet no statistically significant value was achieved (P value = 0.112). Target lesion revascularization was reported in 8 patients in group A and in only 3 patients in group B (P value 0.446).
Despite the evolution in primary PCI strategies and the continuous advancement in anti-thrombotic treatment; pre-interventional infarct related artery TIMI flow grade I-III is associated with better in hospital and 1 year outcome, specifically significantly lower cardiac mortality compared to patients who had TIMI flow grade 0 at initial angiography.
在ST段抬高型心肌梗死（STEMI）中，直接经皮冠状动脉介入治疗（PCI）被认为是最优选的策略。然而，STEMI患者中自发再灌注的预后作用仍不明确。本研究的目的是评估埃及STEMI患者在接受直接PCI治疗时，罪犯冠状动脉术前心肌梗死溶栓治疗（TIMI）血流分级对短期和长期预后的影响。
一项双中心前瞻性观察性研究于2019年1月至2020年6月期间进行，纳入了150例胸痛发作24小时内就诊的STEMI患者。进行了初始血管造影，并分析梗死相关动脉的TIMI血流分级。在150例纳入患者中，93例（62%）初始TIMI血流分级为0级（A组），57例（38%）初始TIMI血流分级为I-III级（B组）。心脏死亡率与术前TIMI血流分级之间存在密切关联。在我们的研究期间记录了12例死亡（占总研究人群的8%）；A组有7例住院死亡，而B组住院期间无死亡记录（P值 = 0.033）。在1年随访时，A组记录了5例死亡，B组无死亡（P值 = 0.005）。A组急性心力衰竭发生率有增加趋势，但未达到统计学显著意义（P值 = 0.112）。A组有8例患者进行了靶病变血管重建，B组仅有3例（P值0.446）。
尽管直接PCI策略不断发展，抗栓治疗也持续进步，但术前梗死相关动脉TIMI血流分级为I-III级与更好的住院及1年预后相关，特别是与初始血管造影时TIMI血流分级为0级的患者相比，心脏死亡率显著降低。
