Severity scale of coronary microvascular obstruction (no-reflow) during percutaneous coronary interventions in myocardial infarction patients

Q4 Medicine

Patologiya krovoobrashcheniya i kardiokhirurgiya Pub Date : 2023-12-26 DOI:10.21688/1681-3472-2023-4-52-63

А.А. Фролов, И.Г. Починка, И.А. Фролов, К.В. Кузьмичев, Александр Станиславович Мухин, Евгений Георгиевич Шарабрин, В.Н. Синютин, Alexey A. Frolov, I. G. Pochinka, Igor A. Frolov, Kirill V. Kuzmichev, Alexey S. Mukhin, E. Sharabrin, Vadim N. Sinyutin

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Abstract

Introduction: There is no scale that combines the traditional criteria of coronary microvascular obstruction (CMVO, no-reflow phenomenon) to effectively assess the severity and prognosis of this complication.Objective: To develop and evaluate the severity scale of CMVO during percutaneous coronary intervention (PCI) for myocardial infarction (MI).Methods: The cohort study included 203 patients diagnosed with type 1 MI and CMVO during PCI. The CMVO criterion was TIMI flow grade (TFG) <3 points. Using the proposed "CMVO Severity Scale" (CMVO-SS), three groups of patients were identified. CMVO grade 1 (mild): TFG 2 points, Myocardial blush grade (MBG) 2–3 points, ST segment resolution after PCI (rST) >70%. CMVO grade 2 (moderate): TFG 2 points, MBG 0–1 points or rST <70%. CMVO grade 3 (severe): TFG 0-1 points.Results: Distribution of groups with CMVO of the 1st, 2nd, and 3rd grade is 65 (32%) / 88 (43%) / 50 (25%) patients, respectively. Outcomes by group: acute heart failure grade 3–4 — 2 (3%) / 11 (13%) / 14 (28%), P < .001; ejection fraction — 48 [44; 53] % / 46 [40; 50] % / 42 [39; 49] %, P = .004; in-hospital death — 1 (1.5%) / 12 (13.6%) / 16 (32.0%), P < .001; two-year death — 8 (12.3%) / 19 (21.6%) / 22 (44.0%), P < .001. The multivariate analysis revealed a two-year death odds ratio for the CMVO-SS of 2.40 [95% CI 1.23–5.17], P = .009. Two-year survival probability with CMVO-SS grade 1 was 87.7%, grade 2 — 78.4%, grade 3 — 56.0% (P < .001).Conclusion: The proposed CMVO severity scale is associated with adverse in-hospital outcomes and two-year mortality. Received 15 May 2023. Revised 27 September 2023. Accepted 24 October 2023. Funding: The study was supported by the "Priority 2030" program. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.A. Frolov, E.G. Sharabrin, I.G. PochinkaData collection and analysis: A.A. Frolov, I.A. Frolov, K.V. KuzmichevStatistical analysis: A.A. Frolov, I.A. Frolov, K.V. KuzmichevDrafting the article: A.A. Frolov, I.G. Pochinka, I.A. FrolovCritical revision of the article: I.G. Pochinka, A.S. Mukhin, E.G. Sharabrin, V.N. SinyutinFinal approval of the version to be published: A.A. Frolov, I.G. Pochinka, I.A. Frolov, K.V. Kuzmichev, A.S. Mukhin, E.G. Sharabrin, V.N. Sinyutin

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心肌梗死患者经皮冠状动脉介入治疗期间冠状动脉微血管阻塞（无回流）的严重程度表

导言：目前还没有一种量表能结合传统的冠状动脉微血管阻塞（CMVO，无回流现象）标准来有效评估这种并发症的严重程度和预后：目前还没有一个结合冠状动脉微血管阻塞（CMVO，无回流现象）传统标准的量表来有效评估这一并发症的严重程度和预后：目的：制定并评估心肌梗死（MI）经皮冠状动脉介入治疗（PCI）期间冠状动脉微血管阻塞（CMVO）的严重程度：这项队列研究纳入了 203 名被诊断为 1 型心肌梗死并在 PCI 过程中发生 CMVO 的患者。CMVO标准为TIMI血流分级（TFG）70%。CMVO 2 级（中度）：TFG 2 分，MBG 0-1 分或 rST <70%。CMVO 3 级（重度）：TFG 0-1 分：结果：1、2、3级CMVO患者的组别分布分别为65（32%）/88（43%）/50（25%）。各组结果：急性心力衰竭 3-4 级 - 2 (3%) / 11 (13%) / 14 (28%)，P < .001；射血分数 - 48 [44; 53] % / 46 [40; 50] % / 42 [39; 49] %，P = .004；院内死亡 - 1 (1.5%) / 12 (13.6%) / 16 (32.0%)，P < .001；两年死亡 - 8 (12.3%) / 19 (21.6%) / 22 (44.0%)，P < .001。多变量分析显示，CMVO-SS 的两年死亡几率比为 2.40 [95% CI 1.23-5.17]，P = .009。CMVO-SS分级1级的两年生存率为87.7%，2级为78.4%，3级为56.0%（P < .001）：结论：拟议的 CMVO 严重程度量表与不良院内预后和两年死亡率相关。2023年5月15日收到。2023年9月27日修订。2023年10月24日接受。资助：本研究得到了 "2030优先 "计划的支持。利益冲突：作者声明无利益冲突。作者贡献构思和研究设计：A.A. Frolov, E.G. Sharabrin, I.G. Pochinka数据收集和分析：A.A. Frolov, E.G. Sharabrin, I.G. Pochinka数据收集和分析：A.A. Frolov、I.A. Frolov、K.V. Kuzmichev统计分析：统计分析：A.A. Frolov, I.A. Frolov, K.V. Kuzmichev文章起草：A.A. Frolov, I.A. Frolov, K.V. KuzmichevA.A. Frolov, I.G. Pochinka, I.A. FrolovCritical revision of the article：I.G. Pochinka、A.S. Mukhin、E.G. Sharabrin、V.N. Sinyutin最终批准出版版本：A.A. Frolov, I.G. Pochinka, I.A. Frolov, K.V. Kuzmichev, A.S. Mukhin, E.G. Sharabrin, V.N. Sinyutin

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