National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
National Institute of Cardiovascular Diseases (NICVD), Hyderabad, Pakistan.
J Interv Cardiol. 2023 Jan 6;2023:4012361. doi: 10.1155/2023/4012361. eCollection 2023.
Distal embolization due to microthrombus fragments formed during predilation ballooning is considered one of the possible mechanisms of slow flow/no-reflow (SF/NR). Therefore, this study aimed to compare the incidence of intraprocedure SF/NR during the primary percutaneous coronary intervention (PCI) in patients with high thrombus burden (≥4 grade) with and without predilation ballooning for culprit lesion preparation. . This prospective descriptive cross-sectional study included patients with a high thrombus burden (≥4 grades) who underwent primary PCI. Propensity-matched cohorts of patients with and without predilation ballooning in a 1 : 1 ratio were compared for the incidence of intraprocedure SF/NR.
A total of 765 patients with high thrombus burden undergoing primary PCI were included in this study. The mean age was 55.75 ± 11.54 years, and 78.6% (601) were males. Predilation ballooning was conducted in 346 (45.2%) patients. The incidence of intraprocedure SF/NR was significantly higher (41.3% vs. 27.4%; < 0.001) in patients with predilation ballooning than in those without preballooning, respectively. The incidence of intraprocedure SF/NR also remained significantly higher for the predilation ballooning cohort with an incidence rate of 41.3% as against 30.1% (=0.002) for the propensity-matched cohort of patients without predilation ballooning with a relative risk of 1.64 (95% CI: 1.20 to 2.24). Moreover, the in-hospital mortality rate remained higher but insignificant, among patients with and without predilation ballooning (8.1% vs. 4.9%; =0.090).
In conclusion, predilation ballooning can be associated with an increased risk of incidence of intraprocedure SF/NR during primary PCI in patients with high thrombus burden.
在预扩张球囊扩张过程中形成的微血栓碎片导致的远端栓塞被认为是慢血流/无复流（SF/NR）的可能机制之一。因此，本研究旨在比较高血栓负荷（≥4 级）患者在罪犯病变准备中进行预扩张球囊扩张与不进行预扩张球囊扩张时，在初次经皮冠状动脉介入治疗（PCI）过程中 SF/NR 的发生率。
本前瞻性描述性病例对照研究纳入了高血栓负荷（≥4 级）接受初次 PCI 的患者。将高血栓负荷（≥4 级）患者按 1：1 比例进行倾向匹配，比较预扩张球囊组和无预扩张球囊组 SF/NR 的发生率。
本研究共纳入 765 例高血栓负荷接受初次 PCI 的患者。患者的平均年龄为 55.75±11.54 岁，78.6%（601 例）为男性。346 例（45.2%）患者进行了预扩张球囊。与无预扩张球囊组相比，进行预扩张球囊的患者 SF/NR 的发生率显著更高（41.3% vs. 27.4%；<0.001）。预扩张球囊组 SF/NR 的发生率也显著高于倾向匹配的无预扩张球囊组，分别为 41.3%和 30.1%（=0.002），相对风险为 1.64（95%CI：1.20 至 2.24）。此外，有和没有预扩张球囊的患者住院死亡率仍然较高，但无统计学意义（8.1% vs. 4.9%；=0.090）。
总之，在高血栓负荷患者中，预扩张球囊可能与初次 PCI 过程中 SF/NR 发生率增加相关。
