Background: Regardless of the remarkable success rates of primary percutaneous coronary intervention (PCI) for patients with ST-elevation MI (STEMI) in recent decades, there remains a substantial number of patients who do not reach complete coronary flow restoration after primary PCI. In this study, we aimed to examine impact coronary flow restoration on long-term prognosis of patients with cardiogenic shock (CS) complicating STEMI.
Methods: We prospectively included patients with CS complicating STEMI who were treated by primary PCI. Degree of coronary flow restoration was evaluated by angiographic TIMI flow grade. All the patients were followed-up until occurrence of death or end of follow-up period. Kaplan–Meier estimation was used to reveal impact of coronary flow restoration after primary PCI and long-term prognosis.
Results: A total of 59 patients with CS complicating STEMI were selected. The mean age was 60 ± 13 years and the majority were men (n=49, 83%). The median follow-up duration was 19.6 months (interquartile range 5.3; 39.6). After primary PCI, complete coronary flow restoration (TIMI 3) was achieved in 46 patients (78%), and 13 patients (22%) had incomplete coronary flow restoration (TIMI ≤2). All-cause mortality during the follow-up period was more likely to be higher in patients who had incomplete coronary flow restoration compared with complete coronary flow restoration (61.5% versus 19.6%, p=0.003). After adjustment for age, culprit vessel, culprit vessel stenosis severity and multivessel disease, only completeness of coronary flow restoration was an independent predictor of long-term prognosis in patients with CS complicating STEMI (HR 0.41, 95% CI [0.22–0.79], p=0.007). Kaplan–Meier analysis showed that patients who had complete coronary flow restoration (TIMI 3) had a significant survival advantage compared with incomplete coronary flow restoration groups (log-rank p<0.001).
Conclusion: Culprit artery flow restoration after primary PCI is an independent long-term marker in patients with CS complicating STEMI, and those patients have a survival advantage compared with incomplete coronary flow restoration.