RESUMEN
Stent strut fracture (SSF) may be an important complication after drug-eluting stent (DES) implantation particularly in patients undergoing sirolimus-eluting stent (SES) implantation. The occurrence of SSF at 6 to 9 months after the SES implantation, which was relatively common, resulted in a higher rate of focal in-stent restenosis. Although this angiographic unfavorable outcome did not lead to an increased risk of adverse cardiac events in the current study, we believe that large-scale prospective studies are needed to elucidate the exact pathophysiology and clinical sequela of the stent strut fracture, including bare metal stents.
Asunto(s)
Enfermedad Coronaria/terapia , Reestenosis Coronaria/etiología , Stents Liberadores de Fármacos/efectos adversos , Enfermedad Coronaria/fisiopatología , Reestenosis Coronaria/fisiopatología , HumanosRESUMEN
AIMS: We aimed to investigate the impact of admission estimated glomerular filtration rates (eGFR) on the development of poor myocardial perfusion after primary percutaneous coronary intervention (pPCI) in patients presenting with acute ST-segment-elevation myocardial infarction (STEMI). MATERIALS AND METHODS: Study population consisted of 80 patients with STEMI (64 men, mean age=67.5+/-6.6 years) undergoing pPCI. Myocardial perfusion was evaluated by using thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG). Patients were divided into two groups according to TMPG after pPCI. Group 1 and 2 consisted of 40 patients with TMPGs 0-1 and 40 patients with TMPGs 2-3, respectively. GFR was calculated based on the abbreviated Modification of Diet in Renal Disease study equation. RESULTS: Admission serum creatine kinase-MB isoenzyme (CKMB) levels and the percentage of lower eGFR (<60 ml/min/1.73 m2) values of the patients with TMPGs 0-1 were significantly higher than those of the patients with TMPGs 2-3 after primary PCI (P=0.007, P<0.001, respectively). Univariate analysis identified pain-to-balloon time, eGFR lower than 60 ml/min/1.73 m2, peak CKMB, and TIMI flow grade 0/1 as the predictors of poor myocardial perfusion. In multivariate analysis peak CKMB, left ventricular ejection fraction less than 35%, admission TIMI flow grade 0/1, lower eGFR and pain-to-balloon time continued to have statistically significant independent association with poor myocardial perfusion in the model. Adjusted odds ratios were calculated as 12.05 for low eGFR [P=0.005; confidence interval (CI): 2.11-68.70], 8.10 for admission TIMI grade 0/1 (P=0.04; CI: 1.37-47.91), 7.04 for pain-to-balloon time (P<0.001; CI: 2.37-20.90), 6.76 for low left ventricular ejection fraction (P=0.03; CI: 1.12-40.61), and 1.02 for CKMB (P=0.01; CI: 1.00-1.04). CONCLUSION: Decreased GFR on admission in patients with STEMI is independently associated with the risk of poor myocardial perfusion following after primary PCI.