Association of End-of-Procedural Angiographic Response with 1-Year Mortality after Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: A Retrospective Cohort Study

Objectives: We evaluated whether the final angiographic result after primary percutaneous coronary intervention (PCI) was associated with 1-year all-cause mortality in patients with ST-segment elevation myocardial infarction (STEMI). Methods: This retrospective single-center cohort study included 222 consecutive patients with STEMI who underwent primary PCI between January 2013 and December 2015. Final thrombolysis in myocardial infarction (TIMI) flow, residual TIMI thrombus grade, and myocardial blush grade (MBG) were recorded at the end of the procedure. An end-of-proce-dural angiographic response phenotype was defined before survival modeling. Optimal response was defined as final TIMI flow 3, residual TIMI thrombus grade 0–1, and MBG 2–3. Suboptimal response was defined as any of the following: final TIMI flow <3, residual TIMI thrombus grade ≥2, or MBG ≤1. Vital status at 1 year was obtained from the national death registry (e-Nabız). Kaplan–Meier analysis and Cox proportional hazards regression were used.
Results: The mean age was 57.9±13.6 years, and 173 patients (77.9%) were male. The median overall follow-up was 620 days (interquartile range, 443–813 days), whereas survival analyses were restricted to the first 365 days after index PCI. In-hospital mortality occurred in 23 patients (10.4%), and 1-year all-cause mortality occurred in 33 (14.9%). Compared with survivors, patients who died by 1 year had lower final TIMI flow, higher residual TIMI thrombus grade, and lower MBG (all p<0.001). The suboptimal angiographic response phenotype was present in 50 patients (22.5%) and was as-sociated with markedly higher 1-year mortality than optimal response (46.0% vs. 5.8%; log-rank p<0.001). In multivari-able Cox analysis adjusted for age, diabetes mellitus, Killip class, and left ventricular ejection fraction (LVEF), suboptimal angiographic response remained independently associated with 1-year mortality (hazard ratio 8.50, 95% confidence interval 3.81–18.94; p<0.001).
Conclusion: Simple end-of-procedural angiographic markers were strongly associated with 1-year mortality after STE-MI. A suboptimal angiographic response phenotype may support early post-PCI risk stratification in routine practice.

Keywords: Coronary Angiography, Mortality, Myocardial Infarction, No-reflow Phenomenon, Percutaneous Coronary Intervention, ST-elevation