Effect of percutaneous coronary intervention with prolonged balloon pre-dilation on coronary flow in ST-segment elevation myocardial infarction.

Abstract

Objective: Coronary artery disease is the leading cause of death worldwide. Prompt revascularisation is crucial once a diagnosis of ST-segment elevation myocardial infarction (STEMI) is established. It is well-known that improved coronary flow and perfusion result in better long-term outcomes. In our study, we aimed to compare the effects of balloon angioplasty with prolonged and brief balloon inflation on coronary flow in primary percutaneous coronary intervention (PCI) in STEMI patients.

Methods: We included 62 patients who presented to our clinic diagnosed with STEMI and underwent primary PCI in our study. Pre-dilation was performed briefly, under 30 seconds (s), in 31 patients, while prolonged balloon dilation exceeding 30 s was conducted in the remaining 31 patients. ST-segment resolutions, laboratory parameters, troponin monitoring, and troponin peak times were collected for both groups before and after the procedure. After revascularisation of the responsible vessel, coronary flow parameters like thrombolysis in myocardial infarction (TIMI) score, TIMI frame count (TIMIfc), and myocardial blush grade (MBG) were evaluated.

Results: Participants in both groups were similar in characteristics aside from the investigated parameters (p >0.05). The troponin peak occurred earlier in those with prolonged balloon inflation times. Electrocardiography (ECG) improvement percentages at 1, 3, and 6 hours were higher in the prolonged balloon group (78.71±21, 92.26±1, 96.77±1) compared to the brief balloon group (60.97±2, 81.94±1, 92.90±1) (p <0.05). Logistic regression showed that increasing age negatively affected TIMI flow grade and myocardial blush grade, while prolonged balloon times had a positive impact (p <0.05).

Conclusion: The current study demonstrated that prolonged balloon pre-dilation yielded superior outcomes compared to brief balloon pre-dilation in primary PCI performed on STEMI patients. These outcomes included enhanced TIMI, TIMIfc, and MBG parameters, along with faster and improved ST-segment resolution, allowing for a more rapid attainment of the troponin peak value. If similar findings are demonstrated in larger studies, standardising the balloon duration could be beneficial in primary PCI of STEMI patients. Thus, improved coronary flow would be associated with better long-term outcomes.