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. 2020 Mar 4;20(1):108.
doi: 10.1186/s12872-020-01386-4.

The diagonal branches and outcomes in patients with anterior ST- elevation myocardial infarction

Shuning Zhang  1   2 , Xin Deng  1   2 , Wenlong Yang  1   2 , Liping Xia  3 , Kang Yao  1   2 , Hao Lu  1   2 , Lei Ge  1   2 , Li Shen  1   2 , Aijun Sun  2 , Yunzeng Zou  1   2 , Juying Qian  1   2 , Junbo Ge  4   5   6   7
Affiliations

The diagonal branches and outcomes in patients with anterior ST- elevation myocardial infarction

Shuning Zhang et al. BMC Cardiovasc Disord. .

Abstract

Background: The management of diagonal branch (D) occlusion is still controversary. The association between the flow loss of D and the prognosis remains unclear. We aim to detect the impact of D flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI).

Methods: Patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI) at our clinic between October 2015 and October 2018were reviewed. Anterior STEMI due to left anterior descending artery (LAD) occlusion with or without loss of the main D flow (TIMI grade 0-1 or 2-3) was enrolled in the analysis. The short- and long-term incidence of major adverse cardiac events (MACEs, a composite of all-cause death, target vessel revascularization and reinfarction) and left ventricular ejection fraction (LVEF) were analyzed.

Results: A total of 392 patients (mean age of 63.9 years) with anterior STEMI treated with primary PCI was enrolled in the study. They were divided into two groups, loss (TIMI grade 0-1, n = 69) and no loss (TIMI grade2-3, n = 323) of D flow, before primary PCI. Compared with the group without loss of D flow, the group with loss of D flow showed a lower LVEF post PCI (41.0% vs. 48.8%, p = 0.003). Meanwhile, loss of D flow resulted in the higher in-hospital, one-month, and 18-month incidence of MACEs, especially in all-cause mortality (all p < 0.05). Landmark analysis further indicated that the significant differences in 18-month outcomes between the two groups mainly resulted from the differences during the hospitalization. In addition, multivariate Cox proportional hazards analysis found that D flow loss before primary PCI was independent factor predicting short- and long-term outcomes in patients with anterior STEMI.

Conclusion: Loss of the main D flow in anterior STEMI patients was independently associated with the higher in-hospital incidences of MACEs and all-cause death as well as the lower LVEF.

Keywords: Diagonal branches; Major adverse cardiac events; Primary percutaneous coronary intervention; ST-segment elevation myocardial infarction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection flow diagram
Fig. 2
Fig. 2
Kaplan-Meier survival analysis of MACE-free (a) rate curve at one month and 18 month (c) and survival rate curve at one month (b) and 18 month (d). MACE, major adverse cardiac event
See this image and copyright information in PMC

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