Watanabe Yusuke, Sakakura Kenichi, Jinnouchi Hiroyuki, Taniguchi Yousuke, Yamamoto Kei, Seguchi Masaru, Tsukui Takunori, Kasahara Taku, Hatori Masashi, Ishibashi Shun, Fujita Hideo
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
Cardiovasc Interv Ther. 2025 Apr;40(2):306-315. doi: 10.1007/s12928-025-01088-8. Epub 2025 Jan 13.
This study aimed to investigate the relationship between the restoration of coronary flow just before stent deployment and the final thrombolysis in myocardial infarction (TIMI) flow grade 3 in patients with ST-segment elevation myocardial infarction (STEMI) whose initial TIMI flow grade ≤ 1. In primary percutaneous coronary intervention (PCI), initial TMI flow grade ≤ 1 is closely associated with suboptimal final TIMI flow grade. We included 466 STEMI patients with initial TIMI flow grade ≤ 1 and divided into a restored flow group or an unrestored flow group according to the TIMI flow grade just before stent deployment. The primary endpoint was the achievement of final TIMI flow grade 3. We compared clinical characteristics between the two groups and performed a multivariate logistic analysis to investigate the association between the coronary flow restoration and the final TIMI flow grade. The prevalence of final TIMI flow grade 3 was significantly higher in the restored flow group than the unrestored flow group. The multivariate logistic regression analysis revealed that the restoration of coronary flow just before stent deployment was significantly associated with final TIMI flow grade 3 (OR 7.771, 95% CI 3.412-17.699, p < 0.001). The restoration of coronary flow just before stent deployment was significantly associated with the achievement of final TIMI flow grade 3 in STEMI patients with initial TIMI flow grade ≤ 1. Interventional cardiologist may pay more attention to the coronary flow restoration just before stent deployment when the initial TIMI flow grade is ≤ 1.
本研究旨在探讨初始心肌梗死溶栓分级（TIMI）≤1级的ST段抬高型心肌梗死（STEMI）患者在支架置入前冠状动脉血流恢复与最终TIMI血流3级之间的关系。在直接经皮冠状动脉介入治疗（PCI）中，初始TIMI血流分级≤1级与最终TIMI血流分级欠佳密切相关。我们纳入了466例初始TIMI血流分级≤1级的STEMI患者，并根据支架置入前的TIMI血流分级将其分为血流恢复组和未恢复组。主要终点是达到最终TIMI血流3级。我们比较了两组的临床特征，并进行多因素逻辑分析以研究冠状动脉血流恢复与最终TIMI血流分级之间的关联。血流恢复组最终TIMI血流3级的发生率显著高于未恢复组。多因素逻辑回归分析显示，支架置入前冠状动脉血流恢复与最终TIMI血流3级显著相关（比值比7.771，95%置信区间3.412 - 17.699，p < 0.001）。在初始TIMI血流分级≤1级的STEMI患者中，支架置入前冠状动脉血流恢复与最终TIMI血流3级的实现显著相关。当初始TIMI血流分级≤1级时，介入心脏病学家可能应更多关注支架置入前的冠状动脉血流恢复情况。
