PMID- 37538975 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20231102 IS - 2168-8184 (Print) IS - 2168-8184 (Electronic) IS - 2168-8184 (Linking) VI - 15 IP - 8 DP - 2023 Aug TI - Myocardial Perfusion in ST-Segment Elevation Myocardial Infarction Patients After Percutaneous Coronary Intervention: Influencing Factors and Intervention Strategies. PG - e42841 LID - 10.7759/cureus.42841 [doi] LID - e42841 AB - Aim We aim to explore the factors influencing myocardial perfusion in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) and evaluate the effects of different intervention strategies on myocardial perfusion improvement. Methods A retrospective analysis was conducted on 300 patients with STEMI who underwent primary percutaneous coronary intervention (PPCI) at our hospital between January 2020 and December 2022. Based on post-procedural coronary angiography results using the thrombolysis in myocardial infarction (TIMI) blood flow grade and myocardial blush grade (MBG), patients were categorized into two groups: the normal perfusion group (TIMI grade 3 or MBG 2-3, n=180) and the impaired perfusion group (TIMI grades 0-2 or MBG 0-1, n=120). The impaired perfusion group was further divided using a random number table into the thrombus aspiration-only group (control group, n=60) and the thrombus aspiration combined with nicorandil group (nicorandil group, n=60). A 1:1 propensity score matching method was employed to adjust for baseline characteristics between the groups. Clinical characteristics, hematological parameters, coronary lesion features, and percutaneous coronary intervention (PCI) technical parameters were compared between the matched groups. Additionally, a multivariate logistic regression analysis was performed to identify independent risk factors influencing myocardial perfusion. Furthermore, the post-procedural myocardial perfusion, cardiac function, and clinical prognosis were compared between the control and nicorandil groups. Results After matching, the baseline characteristics of the two groups were compared. The impaired perfusion group had older age, higher proportion of male patients, higher rates of diabetes and hypertension, longer time from symptom onset to balloon dilation, higher peak cardiac troponin I (cTnI) levels, higher proportion of left main or multivessel involvement, heavier coronary lesion burden, and lower balloon inflation pressure (P<0.05). Multivariate logistic regression analysis revealed that age of >/=65 years (odds ratio OR=2.34, 95% confidence interval CI=1.23-4.46, P<0.01), time from symptom onset to balloon dilation of >/=6 hours (OR=3.12, 95% CI=1.67-5.83, P<0.01), peak cTnI level of >/=100 ng/mL (OR=4.27, 95% CI=2.18-8.36, P<0.01), left main or multivessel involvement (OR=2.86, 95% CI=1.51-5.41, P<0.01), and balloon inflation pressure of <8 atm (OR=3.45, 95% CI=1.79-6.65, P<0.01) were independent risk factors affecting myocardial perfusion. In the intervention analysis, the nicorandil group showed superior post-procedural TIMI blood flow grade, MBG, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) functional classification compared to the control group (P<0.05). During a six-month follow-up, the nicorandil group had a lower incidence of major adverse cardiovascular events (MACE) compared to the control group (P<0.05). Conclusion Age, time from symptom onset to balloon dilation, peak cTnI level, extent of coronary artery lesions, and balloon inflation pressure were identified as independent risk factors affecting myocardial perfusion in STEMI patients after PCI. Compared to simple thrombus aspiration, thrombus aspiration combined with nicorandil demonstrated better improvement in myocardial perfusion, cardiac function, and clinical outcomes for patients with impaired perfusion. CI - Copyright (c) 2023, Tang et al. FAU - Tang, Nan AU - Tang N AD - Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, CHN. FAU - Chen, Xuejin AU - Chen X AD - Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, CHN. FAU - Li, Kangming AU - Li K AD - Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, CHN. FAU - Li, Haoran AU - Li H AD - Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, CHN. FAU - Qi, Chunmei AU - Qi C AD - Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, CHN. LA - eng PT - Journal Article DEP - 20230802 PL - United States TA - Cureus JT - Cureus JID - 101596737 PMC - PMC10394716 OTO - NOTNLM OT - intervention strategies OT - myocardial perfusion OT - percutaneous coronary intervention OT - risk factors OT - st-segment elevation myocardial infarction COIS- The authors have declared that no competing interests exist. EDAT- 2023/08/04 06:43 MHDA- 2023/08/04 06:44 PMCR- 2023/08/02 CRDT- 2023/08/04 04:08 PHST- 2023/08/01 00:00 [accepted] PHST- 2023/08/04 06:44 [medline] PHST- 2023/08/04 06:43 [pubmed] PHST- 2023/08/04 04:08 [entrez] PHST- 2023/08/02 00:00 [pmc-release] AID - 10.7759/cureus.42841 [doi] PST - epublish SO - Cureus. 2023 Aug 2;15(8):e42841. doi: 10.7759/cureus.42841. eCollection 2023 Aug.