Low Ankle-Brachial Index is Associated with Microvascular Coronary Obstruction After Primary PCI
Received 12 November 2020
Accepted for publication 20 January 2021
Published 2 February 2021 Volume 2021:17 Pages 23—32
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Magnus Bäck
Ahmed Abdel-Galeel,1 Ahmed El-Zokaim,2 Hosam Hasan-Ali,1 Ahmed Ibrahim,3 Ayman Ibrahim,2 Ramadan Ghaleb2
1Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt; 2Cardiology Department, Aswan University, Aswan, Egypt; 3Community Medicine Department, Assiut University, Assiut, Egypt
Correspondence: Ahmed Abdel-Galeel
Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
Tel +2 01005015156
Introduction: Percutaneous coronary intervention (PCI) has improved recanalization of infarct-related arteries (IRA); however, TIMI-III flow does not always mean an efficient myocardial reperfusion. Myocardial blush grade (MBG) is used as a predictor for coronary microvascular obstruction. We assessed the association between ankle-brachial index (ABI), a widely used method for diagnosis of peripheral arterial disease (PAD), and coronary microvascular obstruction (MVO) as detected by MBG after primary PCI.
Patients and Methods: The study included 335 patients with ST-elevation myocardial infarction who had primary PCI. History taking, clinical examination, laboratory assessment, ECG and Echocardiography were done for every participant. MBG was assessed for patients after PCI procedure. ABI for all participating patients was calculated.
Results: Two hundred and sixty-one patients fulfilled the inclusion criteria with mean age 58.8 ± 10.7 years, 84% were males. Sixty-one percent had anterior wall myocardial infarction. After primary PCI, despite achieving TIMI flow III in all study patients, only 37% had normal MBG. There was a statistically significant relationship between MBG and site of infarction, left ventricular ejection fraction and ABI. Low ABI was found to predict poor MBG.
Conclusion: Coronary artery disease (CAD) is well linked to PAD. MBG can be used to assess coronary MVO after primary PCI. Poor MBG is associated with low ABI. This could establish a relationship between PAD and coronary MVO after primary PCI.
Keywords: microvascular coronary obstruction, peripheral arterial disease, myocardial blush grade, ankle-brachial index
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