Turk Kardiyol Dern Ars. 2013; 41(6): 486-494 | DOI: 10.5543/tkda.2013.48265
Predictors and long-term prognostic significance of angiographically visible distal embolization during primary percutaneous coronary intervention
, Ayhan Erkol2
, Burak Turan2
, Taylan Akgün3
, Can Yücel Karabay3
, İbrahim Halil Tanboga4
, Selçuk Pala3
, Cevat Kırma3
, Ali Metin Esen31
Department of Cardiology, Medical Park Fatih Hospital, İstanbul2
Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey3
Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul4
Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum
OBJECTIVES We aimed to identify the predictors of angiographically visible distal embolization (AVDE) during primary percutaneous coronary intervention (p-PCI) as well as to assess its impact on short- and long-term clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI).
STUDY DESIGN We retrospectively enrolled 2007 patients with STEMI who underwent p-PCI. We assessed the clinical and angiographic characteristics of patients in order to identify the predictors of AVDE and compared the outcomes of patients with and without AVDE during p-PCI.
RESULTS Distal embolization developed in 135 (6.7%) patients. Age (for each 10- year increase, Odds Ratio (OR) 1.34, 95% Confidence Interval (CI) 1.16-1.52, p<0.001), treatment of right coronary artery (OR 2.52, 95% CI 1.30-4.87, p=0.034), repeated balloon dilatation (OR 1.84, 95% CI 1.16- 2.94, p=0.009), cut-off occlusion pattern (OR 2.17, 95% CI 1.38-3.42, p=0.001), lesion length >15 mm (OR 1.67, 95% CI 1.09-2.58, p=0.019), and reference vessel diameter >3.5 mm (OR 5.08, 95% CI 3.32-7.65, p<0.001) were independent predictors of AVDE. In-hospital (8.1% vs. 3.8%, p=0.014) and one-month (10.8% vs. 4.9%, p=0.004) all-cause mortality rates were higher in patients with AVDE. At the long-term follow-up (median: 42 months), both all-cause (21.5% vs. 10.4%, p<0.001) and cardiac mortality rates (18.4% vs. 8.0%, p<0.001) were higher in patients with AVDE.
CONCLUSION AVDE is associated with worse clinical outcome at both the short- and long-term follow-up of STEMI patients treated early with p-PCI.
Embolization, therapeutic, coronary angiography, coronary thrombosis / diagnosis, myocardial infarction.
How to cite this article
Vecih Oduncu, Ayhan Erkol, Burak Turan, Taylan Akgün, Can Yücel Karabay, İbrahim Halil Tanboga, Selçuk Pala, Cevat Kırma, Ali Metin Esen. Predictors and long-term prognostic significance of angiographically visible distal embolization during primary percutaneous coronary intervention. Turk Kardiyol Dern Ars. 2013; 41(6): 486-494
Corresponding Author: Ayhan Erkol, Türkiye