Extended Balloon Inflation Technique for Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction during Stent Deployment
DOI:
https://doi.org/10.61919/jhrr.v4i2.965Keywords:
Balloon inflation, Myocardial infarction, No-reflow phenomenon, Percutaneous coronary intervention, Prolonged inflation strategy, STEMI, TIMI flow gradeAbstract
Background: Primary percutaneous coronary intervention (PPCI) is the preferred method for treating ST-segment elevation myocardial infarction (STEMI), but the no-reflow phenomenon remains a significant challenge. This study investigates the efficacy of prolonged balloon inflation during stent deployment to reduce the incidence of no-reflow.
Objective: To assess whether extending the duration of balloon inflation during stent deployment in PPCI reduces the incidence of the no-reflow phenomenon compared to the conventional rapid inflation and deflation strategy.
Methods: This randomized controlled trial enrolled 122 patients at the National Institute of Cardiovascular Diseases, Pakistan, from February 2023 to January 2024. Patients were randomly assigned to either prolonged balloon inflation (PBSG) or conventional deployment (CDSG).
Results: The mean age in the PBSG was 59.83±10.10 years, and in the CDSG, it was 60.39±10.16 years. Male participants comprised 51.6%. The PBSG showed significantly lower immediate TIMI flow grades less than 3 (4.9% vs. 26.2%, P = 0.00), no-reflow incidence (0% vs. 26.2%, P = 0.00), corrected TIMI frame counts (36.96±4.25 vs. 46.13±6.82, P = 0.00), and higher ST-segment resolution ≥50% (77.0% vs. 57.4%, P = 0.02). Additionally, 59.0% in the PBSG achieved an MBG of 3 compared to 16.4% in the CDSG (P = 0.00).
Conclusion: Prolonged balloon inflation during stent deployment in PPCI significantly reduces the no-reflow phenomenon and improves myocardial perfusion in patients with STEMI.
Downloads
References
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal. 2018;39(2):119-77.
Hahn J-Y, Song YB, Kim EK, Yu CW, Bae J-W, Chung W-Y, et al. Ischemic postconditioning during primary percutaneous coronary intervention: the effects of postconditioning on myocardial reperfusion in patients with ST-segment elevation myocardial infarction (POST) randomized trial. Circulation. 2013;128(17):1889-96.
Dong M, Mu N, Guo F, Zhang C, Ren F, Li J, et al. The beneficial effects of postconditioning on no-reflow phenomenon after percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction. Journal of thrombosis and thrombolysis. 2014;38:208-14.
Konijnenberg LS, Damman P, Duncker DJ, Kloner RA, Nijveldt R, Van Geuns R-JM, et al. Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction. Cardiovascular research. 2020;116(4):787-805.
Bayramoğlu A, Taşolar H, Kaya A, Tanboğa İH, Yaman M, Bektaş O, et al. Prediction of no‐reflow and major adverse cardiovascular events with a new scoring system in STEMI patients. Journal of Interventional Cardiology. 2018;31(2):144-9.
Reffemann T, Kloner RA. Microvascular alterations after temporary coronary artery occlusion: the no-reflow phenomenon. Journal of cardiovascular pharmacology and therapeutics. 2004;9(3):163-72.
Li R, Zijlstra JG, Kamps JA, van Meurs M, Molema G. Abrupt reflow enhances cytokine-induced proinflammatory activation of endothelial cells during simulated shock and resuscitation. Shock. 2014;42(4):356-64.
Ma M, Wang L, Diao K-y, Liang S-c, Zhu Y, Wang H, et al. A randomized controlled clinical trial of prolonged balloon inflation during stent deployment strategy in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: A pilot study. BMC Cardiovascular Disorders. 2022;22(1):30.
Karwowski J, Poloński L, Gierlotka M, Gąsior M, Bęćkowski M, Kowalik I, et al. Post-procedural TIMI flow grade 2 is not associated with improved prognosis in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary revascularization (PL-ACS registry). Cardiology Journal. 2016;23(4):402-10.
Le May MR, Wells GA, Labinaz M, Davies RF, Turek M, Leddy D, et al. Combined angioplasty and pharmacological intervention versus thrombolysis alone in acute myocardial infarction (CAPITAL AMI study). Journal of the American College of Cardiology. 2005;46(3):417-24.
Booton R. A pharmacogenomic approach to improving response to chemotherapy and improved survival in non-small cell lung cancer: The University of Manchester (United Kingdom); 2005.
Zhao Y, Fu W, Hou X, Zhang J, Biekan J, Zhang H, et al. Myocardial infarct size for predicting improvements in cardiac function in patients with ischemic cardiomyopathy following coronary artery bypass grafting. Quantitative Imaging in Medicine and Surgery. 2023;13(12):7814.
van der Linden LP, Bakx AL, Sedney MI, Buis B, Bruschke AV. Prolonged dilation with an autoperfusion balloon catheter for refractory acute occlusion related to percutaneous transluminal coronary angioplasty. Journal of the American College of Cardiology. 1993;22(4):1016-23.
Asano T, Kobayashi Y, Fukushima K, Iwata Y, Kitahara H, Ishio N, et al. Effect of balloon inflation time on expansion of sirolimus-eluting stent. Heart and vessels. 2009;24:335-9.
Ann SH, CHUNG JW, DE JIN C, Lee JH, Kim JM, Garg S, et al. Better inflation time of stent balloon for second‐generation drug‐eluting stent expansion and apposition: An optical coherence tomography study. Journal of Interventional Cardiology. 2014;27(2):171-6.
Cook JR, Mhatre A, Wang FW, Uretsky BF. Prolonged high‐pressure is required for optimal stent deployment as assessed by optical coherence tomography. Catheterization and Cardiovascular Interventions. 2014;83(4):521-7.
Torabi A, Cleland JG, Khan NK, Loh PH, Clark AL, Alamgir F, et al. The timing of development and subsequent clinical course of heart failure after a myocardial infarction. European heart journal. 2008;29(7):859-70.
Brosh D, Assali AR, Mager A, Porter A, Hasdai D, Teplitsky I, et al. Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. The American journal of cardiology. 2007;99(4):442-5.
Durante A, Camici PG. Novel insights into an “old” phenomenon: the no reflow. International journal of cardiology. 2015;187:273-80.
Van Kranenburg M, Magro M, Thiele H, de Waha S, Eitel I, Cochet A, et al. Prognostic value of microvascular obstruction and infarct size, as measured by CMR in STEMI patients. JACC: Cardiovascular Imaging. 2014;7(9):930-9.
Barbato E, Marco J, Wijns W. Direct stenting. European heart journal. 2003;24(5):394-403.
Loubeyre C, Morice M-C, Lefèvre T, Piéchaud J-F, Louvard Y, Dumas P. A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction. Journal of the American College of Cardiology. 2002;39(1):15-21.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Muhammad Rafeeq Shah, Khalid Naseeb, Muhammad Nauman Khan, Asif Hussain, Tahir Saghir
This work is licensed under a Creative Commons Attribution 4.0 International License.
