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Predictors of angiographically visible distal embolization in STEMI

Prädiktoren der angiographisch sichtbaren distalen Embolie bei STEMI

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Abstract

Background

Distal embolization during primary percutaneous coronary intervention (p-PCI) in the treatment of ST-segment elevation myocardial infarction (STEMI) is associated with a poor prognosis. In this situation, thrombectomy is performed to prevent distal embolization and to restore myocardial reperfusion. The aim of our study was to determine angiographic predictors of angiographically visible distal embolization (AVDE) in patients with STEMI treated by p‑PCI with thrombectomy.

Patients and methods

This prospective study included all consecutive patients who underwent p‑PCI with thrombectomy for STEMI at our institution between October 2011 and December 2014 AVDE was defined as a distal filling defect with an abrupt cut-off in one of the peripheral coronary branches of the infarct-related artery, distal to the angioplasty site. Thrombectomy was considered positive when it removed thrombi, and successful when it improved coronary flow.

Results

Among the 346 patients included, 59 (17%) developed AVDE during p‑PCI. In multivariate analysis, the infarct-related right coronary artery (OR: 2.48, 95% CI: 1.36–4.52; p = 0.003) and a culprit lesion diameter of >3 mm (OR : 1.90, 95% CI: 1.01–3.56; p = 0.048) were identified as independent factors associated with AVDE during p‑PCI with thrombectomy for STEMI. The success of thrombectomy and the Syntax score were not associated with AVDE.

Conclusion

AVDE complicating p‑PCI with thrombectomy in STEMI is frequent (17%) and a successful thrombectomy does not rule out AVDE.

Zusammenfassung

Hintergrund

Die distale Embolie während einer primären perkutanen Koronarintervention (p-PCI) zur Therapie des ST-Strecken-Hebungs-Infarkts (STEMI) geht mit einer schlechten Prognose einher. In dieser Situation wird eine Thrombektomie durchgeführt, um einer distalen Embolie vorzubeugen und die Myokardperfusion wiederherzustellen. Ziel der vorliegenden Studie war es, angiographische Prädiktoren einer angiographisch sichtbaren distalen Embolie („angiographically visible distal embolization“, AVDE) bei Patienten mit STEMI und Behandlung durch p‑PCI mit Thrombektomie zu ermitteln.

Patienten und Methoden

In die vorliegende prospektive Studie wurden alle aufeinanderfolgenden Patienten eingeschlossen, bei denen zwischen Oktober 2011 und Dezember 2014 eine p‑PCI mit Thrombektomie zur Therapie eines STEMI an der Klinik der Autoren erfolgte. Eine AVDE wurde als distaler Füllungsdefekt mit abruptem Abbruch in einem der peripheren Äste der infarktbeteiligten Koronararterie definiert, und zwar distal der Stelle der Angioplastie. Eine Thrombektomie galt als positiv, wenn damit Thromben entfernt wurden, und als erfolgreich, wenn sie zu einer Verbesserung des Koronarflusses führte.

Ergebnisse

Von den 346 in die Studie eingeschlossenen Patienten trat bei 59 (17 %) eine AVDE während der p‑PCI auf. In der multivariaten Analyse stellten sich die infarktbeteiligte rechte Koronararterie (Odds Ratio, OR: 2,48; 95 %-Konfidenzintervall, 95 %-KI: 1,36–4,52; p = 0,003) und ein Durchmesser der verursachenden Läsion von >3 mm (OR: 1,90; 95 %-KI: 1,01–3,56; p = 0,048) als unabhängige Faktoren heraus, die mit einer AVDE während der p‑PCI mit Thrombektomie wegen eines STEMI assoziiert waren. Die Erfolgsrate der Thrombektomie und der Syntax-Score waren nicht mit einer AVDE vergesellschaftet.

Schlussfolgerung

Eine AVDE als Komplikation einer p‑PCI mit Thrombektomie bei STEMI ist häufig (17 %), und eine erfolgreiche Thrombektomie schließt eine AVDE nicht aus.

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Abbreviations

AVDE:

Angiographically visible distal embolization

IRA:

Infarct-related coronary artery

LDA:

Left descending artery

p-PCI:

Primary percutaneous coronary intervention

RCA:

Right coronary artery

STEMI:

ST-segment elevation myocardial infarction

TIMI:

Thrombolysis in Myocardial Infarction

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Funding

This work was supported by the University Hospital of Dijon, the Faculty of Medicine of Dijon, the Association de Cardiologie de Bourgogne, and by grants from the Union Régionale des Caisses d’Assurance Maladie de Bourgogne (URCAM), the Agence Regionale de Santé (ARS) de Bourgogne, the Conseil Régional de Bourgogne and the Fédération Française de Cardiologie (FFC).

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Authors and Affiliations

  1. Cardiology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France

    N. V. Yaméogo MD, PhD, C. Guenancia MD PhD, G. Porot MD, K. Stamboul MD PhD, C. Richard MD PhD, A. Gudjoncik MD PhD, J. Hamblin MD, P. Buffet MD, L. Lorgis MD PhD & Y. Cottin MD PhD

  2. PEC2, UFR Sciences de Santé, Univ. Bourgogne Franche-Comté, Dijon, France

    C. Guenancia MD PhD, K. Stamboul MD PhD, C. Richard MD PhD, A. Gudjoncik MD PhD, L. Lorgis MD PhD & Y. Cottin MD PhD

Authors
  1. N. V. Yaméogo MD, PhD
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  2. C. Guenancia MD PhD
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  3. G. Porot MD
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  4. K. Stamboul MD PhD
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  6. A. Gudjoncik MD PhD
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  7. J. Hamblin MD
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  8. P. Buffet MD
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  9. L. Lorgis MD PhD
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  10. Y. Cottin MD PhD
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Corresponding author

Correspondence to C. Guenancia MD PhD.

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Conflict of interest

V.N. Yaméogo, C. Guenancia, G. Porot, K. Stamboul, C. Richard, A. Gudjoncik, J. Hamblin, P. Buffet, L. Lorgis, and Y. Cottin declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Yaméogo, N.V., Guenancia, C., Porot, G. et al. Predictors of angiographically visible distal embolization in STEMI. Herz 45, 288–292 (2020). https://doi.org/10.1007/s00059-018-4723-1

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  • DOI: https://doi.org/10.1007/s00059-018-4723-1

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