Background: Primary percutaneous coronary intervention (PPCI) is the most effective and validated treatment strategy of ST segment elevation myocardial infarction (STEMI). Nevertheless, normal myocardial perfusion cannot always be achieved at the end of the procedure in a significant number of patients with STEMI. The aim of this study was to investigate angiographic and procedural predictors of angiographically visible distal embolization (AVDE) during PPCI and the assessment of mid and long term mortality.
Methods: Four hundred and sixty five consecutive patients undergoing PPCI for acute STEMI and matching eligibility criteria of the study between January 2010 and December 2011 were enrolled in the study. Patients were divided into two groups; 61 (13.1%) with AVDE and 404 patients without AVDE based on angiograms performed during PPCI.
Results: Longer stent length, higher balloon diameter, low Syntax score (SxS), low LVEF, high neutrophil/lymphocyte ratio and chronic renal failure were seemed to be associated with AVDE in univariate analysis and these variables were entered into multivariate analysis. In multivariate analyzes, stent length, LVEF and low SxS were found to be associated with AVDE (OR: 1,11, 95 % CI: 1,06-1,16, p< 0,001; OR: 0,80, 95%CI: 0.80-0.91, p< 0,001; OR: 0,85, 95%CI: 0,79-0,91, P< 0,001, respectively).
Conclusions: This study concluded that low SxS, longer stent length, low LVEF were predicting risk factors associated with the development of AVDE in patients undergoing PPCI. Low SxS associated with AVDE may be linked to the strong relation between AVDE and high thrombus burden and composition of atherosclerotic plaque rather than complex coronary lesions.