Cardiovascular Journal of Africa: Vol 28 No 3 (May/June 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017 186 AFRICA
Symptom-to-balloon time and myocardial blush grade
are predictors of left ventricular remodelling after
successful primary percutaneous coronary intervention
El‑Sayed M Farag, Mohammad M Al-Daydamony
Abstract
Introduction: In patients with ST-segment elevation myocar-
dial infarction (STEMI), successful primary percutaneous
coronary intervention (PCI) was found to be useful in earlier
restoration of TIMI flow 3. However, the incidence of left
ventricular (LV) dilatation and remodelling after success-
ful primary PCI is still high. We aimed to determine the
independent predictors of LV remodelling after successful
primary PCI for patients with first STEMI.
Methods: We included 232 STEMI patients treated with primary
PCI. Echocardiography was done on the day of PCI and after
six months. LV remodelling was defined as ≥ 20% increase in
the six-month left ventricular end-diastolic volume (LVEDV).
Results: In patients with remodelling, symptom-to-door and
symptom-to-balloon times were significantly longer (p <
0.00001 for each), initial ejection fraction (EF) was signifi-
cantly lower (p = 0.044), six-month LVEDV, left ventricular
end-systolic volume (LVESV) and LVEDV increase were
significantly higher, and EF was significantly lower (p <
0.00001 for each). Mean myocardial blush grade (MBG)
was significantly lower in patients with remodelling (p <
0.00001). There was a significant positive correlation between
LVEDV increase and both symptom-to-balloon time (r =
0.603, p < 0.00001) and symptom-to-door time (r = 0.564,
p < 0.00001), and a significant negative correlation between
LVEDV increase and MBG (r = –0.447, p < 0.00001). Logistic
regression showed that the independent predictors of LV
remodelling were symptom-to-balloon time (p = 0.00068),
symptom to door time (p = 0.0013) and MBG (p = 0.0057).
Conclusion: Symptom-to-door time, symptom-to-balloon time
and MBG were the only significant predictors of LV remodelling.
Keywords: primary PCI, left ventricular remodelling, myocardial
blush, symptom-to-balloon time
Submitted 6/5/16, accepted 15/9/16
Published online 27/10/16
Cardiovasc J Afr 2017; 28: 186–190
DOI: 10.5830/CVJA-2016-085
ST-segment elevation myocardial infarction (STEMI) is one of
the most important causes of death and disability around the
world.1 Heart failure (HF) is a serious sequel of STEMI. Left
ventricular (LV) remodelling was found to be the precursor to
developing HF and also an important predictor of prognosis
after STEMI.2
When compared with fibrinolytic therapy for STEMI patients,
successful primary percutaneous coronary intervention (PCI)
was found to be useful in earlier restoration of thrombolysis in
myocardial infarction (TIMI) flow grade 3 flow in the infarct-
related artery, it limited the infarction size, and decreased heart
failure and mortality rates.3 However, the incidence of LV
dilatation after successful primary PCI is still high.4
Previous studies have searched for predictors of LV
remodelling after primary PCI. Regional and global LV systolic
dysfunction, severe LV diastolic abnormalities,5 lower LV
ejection fraction at discharge,6 and poorer myocardial perfusion
as assessed by myocardial blush grade (MBG)6,7 were found to be
significant predictors of LV remodelling. However, these studies
were performed on relatively small numbers of patients. The aim
of our study was to determine the independent predictors of LV
remodelling after successful primary PCI for patients with first
STEMI.
Methods
This prospective study was done in the coronary care and cardiac
catheterisation units of the Cardiology Department, Zagazig
University. The study population consisted of 260 patients who
were admitted with acute STEMI during the period between
January 2012 and January 2015.
The inclusion criteria were: confirmed acute STEMI, defined
as the presence of typical chest pain that lasts for at least 20
minutes, and ST-segment elevation ≥ 0.1 mV in at least two
contiguous leads;8primary PCI done within 12 hours of the onset
of symptoms; successfully performed PCI with < 20% residual
stenosis and TIMI flow 3 of the infarct-related artery defined as
normal flow, which fills the distal coronary bed completely.9
Patients were excluded from our study in the presence of one
or more of the following: previous history of coronary artery
disease (CAD), myocardial infarction, or revascularisation;
more than mild valvular stenosis or regurgitation; patients with
left bundle branch block; and unsatisfactory echocardiographic
images.
We had a written informed consent from every patient. The
study protocol was approved by the institutional review board of
the Faculty of Medicine, Zagazig University.
A full history was taken and a complete clinical examination
was done on every patient. The time of onset of chest pain
(symptom time), the time of the patient’s arrival at the hospital
(door time), and the time of first balloon inflation or stent
deployment (balloon time) were carefully recorded.
Cardiology Department, Faculty of Medicine, Zagazig
University, Zagazig, Al-Sharkia, Egypt
El‑Sayed M Farag, MD
Mohammad M Al-Daydamony, MD,