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. 2023 Dec 11;15(12):e50340.
doi: 10.7759/cureus.50340. eCollection 2023 Dec.

Acute Heart Failure and Coronary Blood Flow in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: An Observational Cohort Study

Amr Elkammash  1 , Mohamed Abdelhamid  2 , Mohamed Sobhy  2 , Amr Zaki  2 , Mohamed Sadaka  2 , Oluwamayowa N Omoniyi  3 , Mustafa Alsinan  4 , Rasha M Farahat  5 , Aya Al Sattouf  6 , Khaled Madi  7
Affiliations

Acute Heart Failure and Coronary Blood Flow in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: An Observational Cohort Study

Amr Elkammash et al. Cureus. .

Abstract

Background and objective The Global Registry of Acute Coronary Events (GRACE) study showed poor outcomes in ST-elevation myocardial infarction (STEMI) patients with acute heart failure (AHF) at hospital admission in terms of increased in-hospital and six-month mortality and readmission rates. In this study, we aimed to examine the effects of AHF at the time of admission on the coronary thrombus burden and post-primary percutaneous coronary intervention (PPCI) coronary flow among STEMI patients. Methods We conducted a cohort study involving 210 consecutive STEMI patients who presented to a single PPCI centre between June 2016 and January 2017. We classified them into two groups based on their Killip class at the time of presentation to the emergency department: no heart failure (NHF) and AHF groups. The primary outcome was the incidence of Thrombolysis In Myocardial Infarction (TIMI) flow grade of less than 3 in the stented coronary artery in the absence of mechanical obstruction or dissection (also known as no-reflow). The secondary outcome was the presence of a heavy thrombus burden (TIMI grade 4 or 5) at the time of angiography. Results The AHF group had a significantly higher incidence of no-reflow than the NHF group (25% vs. 8.4%, p=0.019). However, the prevalence of heavy thrombus burden did not differ significantly between the two groups (50% in the AHF group vs. 43.16% in the NHF group, p=0.557). The multivariable logistic regression analysis showed that AHF was an independent predictor of no-reflow in STEMI patients post-PPCI [Odds ratio (OR): 3.59, 95% confidence interval (CI): 1.09-11.83, p=0.035]. Conclusion Based on our findings, AHF is associated with an increased risk of no-reflow in STEMI patients post-PPCI, irrespective of the coronary thrombus load.

Keywords: coronary flow; killip; neurohumoral; no-reflow; perfusion; stemi; thrombus.

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Conflict of interest statement

The first and corresponding author (Dr Amr Elkammash) worked as a Cardiology specialist in the International Cardiac Center, Alexandria, Egypt, at the time when the study was carried out, and his current affiliation represents his most recent place of work. The study’s abstract was presented at the Acute Cardiovascular Care Conference held in Marseille, France in 2023, and was published in the ESC Acute Cardiovascular Care journal supplement in May 2023. However, the detailed manuscript has never been published before.

Figures

Figure 1
Figure 1. The incidence of no-reflow in STEMI patients with and without AHF on admission
STEMI: ST-elevation myocardial infarction; AHF: acute heart failure; PPCI: primary percutaneous coronary intervention
Figure 2
Figure 2. The angiographic thrombus burden in STEMI patients with and without AHF on admission
STEMI: ST-elevation myocardial infarction; AHF: acute heart failure
See this image and copyright information in PMC

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