Yüksek trombüs yükü olan hastalarda koroner stentleme sonrası no-reflow gelişiminin prediktörleri

Abstract

Amaçlar: Bu çalışmada, yüksek trombüs yükü olan hastalarda koroner stentleme sonrası no-reflow gelişiminin öngörücülerini ortaya koymayı amaçladık. Yöntemler: Merkezimizde Şubat 2020 ile Temmuz 2022 tarihleri arasında yüksek trombüs yükü olan koroner lezyonuna aynı seansta stentleme yapılan hastalar bu retrospektif çalışmaya dahil edildi. Yüksek trombüs yükü TIMI derece 4 veya 5 trombüs olarak kabul edildi. No-reflow işlem sonunda TIMI derece ≤2 akım olarak kabul edildi. No-reflow gelişiminin öngörücülerini tespit etmek için çok değişkenli lojistik regresyon analizi yapıldı. Bulgular: Çalışmaya dahil edilen 485 hastanın 407'sinde (%83,9) no-reflow gelişmemişti. İşlem sonunda no-reflow gelişen 78 (%16,1) hastanın 61'inde TIMI 2, 10'unda TIMI 1, 7'sinde TIMI 0 akım mevcuttu. Yaş [odds oranı (OO) 1,051; %95 güven aralığı (GA) 1,021-1,082; P = ,001], oklüzyon proksimalinde birikmiş trombüs (OO 3,318; %95 GA 1,176-9,365; P = ,023), referans damar çapının (RDÇ) 4 mm'den büyük olması (OO 2,569; %95 GA 1,005-6,565; P = ,049) ve telleme veya küçük balonla dilatasyon sonrası TIMI akım derecesi (OO 0,108; %95 GA 0,065-0,181; P <,001) no-reflow gelişiminin bağımsız öngörücüleriydi. Sonuç: İleri yaş, oklüzyon proksimalinde birikmiş trombüs, 4 mm'den büyük RDÇ ve telleme veya küçük balonla dilatasyon sonrası TIMI derece 3 akımın olmaması yüksek trombüs yükü olan hastalarda koroner stentleme sonrası artmış no-reflow riski ile ilişkili olabilir.

Keywords

• No-reflow
• koroner stentleme
• yüksek trombüs yükü

Predictors of no-reflow after coronary stenting in patients with high thrombus burden

Abstract

Aims: In this study, we aimed to reveal the predictors of no-reflow after coronary stenting in patients with high thrombus burden. Methods: Patients with acute myocardial infarction who underwent stenting of a coronary lesion with high thrombus burden in the same session between February 2020 and July 2022 in our center were included in this retrospective study. High thrombus burden was accepted as Thrombolysis in Myocardial Infarction (TIMI) grade 4 or 5 thrombus. No-reflow was accepted as TIMI grade ≤2 flow at the end of the procedure. Multivariate logistic regression analysis was executed to ascertain the predictors of no-reflow. Results: Of the 485 patients included in the study, 407 (83.9%) did not develop no-reflow. Of the 78 (16.1%) patients who developed no-reflow at the end of the procedure, 61 had TIMI 2, 10 had TIMI 1, and 7 had TIMI 0 flow. Age [odds ratio (OR) 1.051; 95% confidence interval (CI) 1.021-1.082; p=.001], accumulated thrombus proximal to the occlusion (OR 3.318; 95% CI 1.176-9.365; p=.023), reference vessel diameter (RVD) greater than 4 mm (OR 2.569; 95% CI 1.005-6.565; p=.049), and TIMI flow grade after wiring or small balloon dilation (OR 0.108; 95% CI 0.065-0.181; p<.001) were the independent predictors of no-reflow. Conclusion: Older age, accumulated thrombus proximal to the occlusion, RVD greater than 4 mm, and the absence of TIMI grade 3 flow after wiring or small balloon dilation may be associated with an increased risk of no-reflow after coronary stenting in patients with high thrombus burden.

Keywords

• No-reflow
• coronary stenting
• high thrombus burden

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