Coronary microvascular obstruction in percutaneous coronary interventions in myocardial infarction patients: a comprehensive approach to prevention and treatment

Objective: The study intends to evaluate the prognostic value of a comprehensive approach to prevention and treating the coronary microvascular obstruction (CMVO) upon percutaneous coronary interventions (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A single-center cohort study was conducted in patients characterizing by type 1 STEMI, emergency PCI, a total ischemic time of less than 12 hours, and the development of CMVO (TIMI flow grade < 3 or Myocardial blush grade < 2). Patients with cardiogenic shock prior to PCI were excluded. A proposed comprehensive approach included the following five rules: thromboaspiration in case of severe thrombosis, platelet glycoprotein IIb/IIIa receptor blockers, "minimally invasive PCI," intracoronary administration of isosorbide dinitrate and verapamil hydrochloride upon the development of CMVO. The approach was considered to be applied if three or more rules were retained. The median follow-up period was 805 [14; 1,127] days. A multivariate analysis of the risk of long-term mortality was performed using the Cox proportional hazards model. Results: A total of 202 patients were included in the study and 53 (26.3%) of them had a fatal outcome; in particular, 16 (7.9%) patients died at the hospital stage and 27 (13.4%) after discharge. Multivariate analysis of predictors of mortality showed that the using of a comprehensive approach to prevention and treating CMVO reduces the probability of death during follow-up period by 4 times with risk ratio 0.22, 95% confidence interval 0.06–0.87 and p = 0.03. Conclusion: The introducing of the proposed comprehensive approach to prevention and treating CMVO upon PCI in patients with STEMI is associated with a lower probability of death within 805 days after the intervention.