Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2022; 10(7): 2106-2114
Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2106
Postoperative adverse cardiac events in acute myocardial infarction with high thrombus load and best time for stent implantation
Ming-Feng Zhuo, Ke-Lian Zhang, Xue-Bin Shen, Wen-Can Lin, Bin Hu, Hua-Peng Cai, Gang Huang
Ming-Feng Zhuo, Wen-Can Lin, Bin Hu, Hua-Peng Cai, Gang Huang, Department of Emergency, Shishi General Hospital, Shishi 362700, Fujian Province, China
Ke-Lian Zhang, Department of Cardiovascular, Quanzhou First Hospital, Quanzhou 362000, Fujian Province, China
Xue-Bin Shen, Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping 353000, Fujian Province, China
Author contributions: Zhuo MF and Zhang KL contributed equally to this article and should be regarded as co-first authors; Zhuo MF and Zhang KL designed the experiment; Shen XB drafted the work; Lin WC, Hu B, and Cai HP collected the data; Huang G and Zhuo MF analyzed and interpreted data; Zhang KL, Shen XB, and Lin WC wrote the manuscript.
Supported by Quanzhou Science and Technology Bureau Approved the Project, Quanzhou Science and Technology Plan Project, No. 2019N008S.
Institutional review board statement: This study was approved by Medical Ethics Committee of Shishi General Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gang Huang, BM BCh, Chief Doctor, Department of Emergency, Shishi General Hospital, Shishi 362700, No. 2156 Shijin Road, Fujian Province, China. huanggangdoctor@163.com
Received: November 24, 2021
Peer-review started: November 24, 2021
First decision: December 9, 2021
Revised: December 17, 2021
Accepted: January 22, 2022
Article in press: January 22, 2022
Published online: March 6, 2022
Processing time: 97 Days and 18.6 Hours
Abstract
BACKGROUND

Myocardial infarction is one of the most common types of coronary heart disease. It is mainly caused by the rupture of coronary atherosclerotic plaque, which leads to platelet agglutination and thrombosis. The occlusion of coronary arteries and vessels leads to insufficient myocardial blood supply, subsequently causing cardiac interstitial fibrosis, gradual enlargement of ventricles, and heart failure, which affects the quality of life and safety of patients.

AIM

To investigate the effects of emergency percutaneous interventional therapy (PCI) and delayed stenting in acute myocardial infarction with high thrombotic load and identify factors related to major adverse cardiovascular events (MACE).

METHODS

A total of 164 patients with acute myocardial infarction and high thrombotic load who received PCI were included. Of them, 92 patients were treated with delayed stent implantation (delayed group) and 72 patients received emergency PCI (immediate group). Myocardial perfusion after stent implantation was compared between the two groups. Patients were followed up for 12 mo, and the occurrence of MACE was used as the endpoint. Univariate and multivariate models were used to analyze the factors affecting MACE occurrence.

RESULTS

After stent implantation, 66 (71.74%) patients in the delayed group and 40 (55.56%) patients in the immediate group had thrombolysis in myocardial infarction (TIMI) flow grade 3 (P < 0.05), while 61 (66.30%) patients in the delayed group and 39 (54.17%) patients in the immediate group reached TIMI myocardial perfusion grade 3 (P > 0.05). MACE occurred in 29 patients. There were statistically significant differences between the MACE and non-MACE groups in diabetes rate, TIMI grading, stent implantation timing, intraoperative use of tirofiban, and the levels of white blood cells (WBC), neutrophils, red blood cell distribution width (RDW), and uric acid, and high-sensitivity C-reactive protein (hs-CRP) at admission (P < 0.05). Logistic regression analysis showed that TIMI grade 3 and intraoperative use of tirofiban effectively reduced the risk of MACE (P < 0.05), while immediate stent implantation, increased WBC, hs-CRP and RDW on admission increased the risk of MACE (P < 0.05).

CONCLUSION

Delayed stent implantation outweighs emergency PCI in improving postoperative myocardial perfusion in acute myocardial infarction with high thrombotic load, and effectively reduces MACE in these patients.

Keywords: Coronary thrombosis; Myocardial infarction; Emergency; Percutaneous coronary intervention; Treatment delay; Adverse cardiovascular events

Core Tip: This study compared delayed stent implantation with emergency percutaneous intervention in terms of myocardial perfusion after stent implantation in 164 patients with acute myocardial infarction and high thrombotic load using univariate and multivariate models. Obtained results showed that delayed stent implantation is more beneficial than emergency percutaneous coronary intervention in improving postoperative myocardial perfusion in acute myocardial infarction with high thrombotic load, and effectively reduces major adverse cardiovascular events in these patients.