Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction

Abstract In percutaneous coronary intervention (PCI) to the culprit lesion of acute myocardial infarction (AMI), unsuccessful guidewire crossing causes immediate poor outcomes. It is important to determine the factors associated with unsuccessful guidewire crossing in AMI lesions. The purpose of thi...

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Autores principales:	Shun Ishibashi, Kenichi Sakakura, Satoshi Asada, Yousuke Taniguchi, Hiroyuki Jinnouchi, Takunori Tsukui, Kei Yamamoto, Masaru Seguchi, Hiroshi Wada, Hideo Fujita
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c0577a1f5126434c87d11c23fcd30f3d
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spelling	oai:doaj.org-article:c0577a1f5126434c87d11c23fcd30f3d2021-11-08T10:48:36ZFactors associated with difficulty in crossing the culprit lesion of acute myocardial infarction10.1038/s41598-021-00832-32045-2322https://doaj.org/article/c0577a1f5126434c87d11c23fcd30f3d2021-11-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-00832-3https://doaj.org/toc/2045-2322Abstract In percutaneous coronary intervention (PCI) to the culprit lesion of acute myocardial infarction (AMI), unsuccessful guidewire crossing causes immediate poor outcomes. It is important to determine the factors associated with unsuccessful guidewire crossing in AMI lesions. The purpose of this study was to find factors associated with difficulty in crossing the culprit lesion of AMI. We defined the difficult group when the guidewire used to cross the culprit lesion was a polymer jacket type guidewire or a stiff guidewire. We included 937 patients, and divided those into the non-difficult group (n = 876) and the difficult group (n = 61). Proximal reference diameter was significantly smaller in the difficult group than in the non-difficult group (p < 0.001), and degree of calcification was severer in the difficult group than in the non-difficult group (p < 0.001). In the multivariate stepwise logistic regression analysis, proximal reference diameter [odds ratio (OR) 0.313, 95% confidence interval (CI) 0.185–0.529, p < 0.001)], previous PCI (OR 3.065, 95% CI 1.612–5.830, p = 0.001), moderate-severe calcification (OR 4.322, 95% CI 2.354–7.935, p < 0.001), blunt type obstruction (OR 12.646, 95% CI 6.805–23.503, p < 0.001), and the presence of collateral to the culprit lesion (OR 2.110, 95% CI 1.145–3.888, p = 0.017) were significantly associated with difficulty in crossing the culprit lesion. In conclusion, previous PCI, calcification, blunt type obstruction, and the presence of collateral were associated with difficulty in crossing the culprit lesion, whereas proximal reference diameter was inversely associated with difficulty. Our study provides a reference to recognize the difficulty in crossing the culprit lesions of AMI for PCI operators, especially junior operators.Shun IshibashiKenichi SakakuraSatoshi AsadaYousuke TaniguchiHiroyuki JinnouchiTakunori TsukuiKei YamamotoMasaru SeguchiHiroshi WadaHideo FujitaNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Shun Ishibashi Kenichi Sakakura Satoshi Asada Yousuke Taniguchi Hiroyuki Jinnouchi Takunori Tsukui Kei Yamamoto Masaru Seguchi Hiroshi Wada Hideo Fujita Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction
description	Abstract In percutaneous coronary intervention (PCI) to the culprit lesion of acute myocardial infarction (AMI), unsuccessful guidewire crossing causes immediate poor outcomes. It is important to determine the factors associated with unsuccessful guidewire crossing in AMI lesions. The purpose of this study was to find factors associated with difficulty in crossing the culprit lesion of AMI. We defined the difficult group when the guidewire used to cross the culprit lesion was a polymer jacket type guidewire or a stiff guidewire. We included 937 patients, and divided those into the non-difficult group (n = 876) and the difficult group (n = 61). Proximal reference diameter was significantly smaller in the difficult group than in the non-difficult group (p < 0.001), and degree of calcification was severer in the difficult group than in the non-difficult group (p < 0.001). In the multivariate stepwise logistic regression analysis, proximal reference diameter [odds ratio (OR) 0.313, 95% confidence interval (CI) 0.185–0.529, p < 0.001)], previous PCI (OR 3.065, 95% CI 1.612–5.830, p = 0.001), moderate-severe calcification (OR 4.322, 95% CI 2.354–7.935, p < 0.001), blunt type obstruction (OR 12.646, 95% CI 6.805–23.503, p < 0.001), and the presence of collateral to the culprit lesion (OR 2.110, 95% CI 1.145–3.888, p = 0.017) were significantly associated with difficulty in crossing the culprit lesion. In conclusion, previous PCI, calcification, blunt type obstruction, and the presence of collateral were associated with difficulty in crossing the culprit lesion, whereas proximal reference diameter was inversely associated with difficulty. Our study provides a reference to recognize the difficulty in crossing the culprit lesions of AMI for PCI operators, especially junior operators.
format	article
author	Shun Ishibashi Kenichi Sakakura Satoshi Asada Yousuke Taniguchi Hiroyuki Jinnouchi Takunori Tsukui Kei Yamamoto Masaru Seguchi Hiroshi Wada Hideo Fujita
author_facet	Shun Ishibashi Kenichi Sakakura Satoshi Asada Yousuke Taniguchi Hiroyuki Jinnouchi Takunori Tsukui Kei Yamamoto Masaru Seguchi Hiroshi Wada Hideo Fujita
author_sort	Shun Ishibashi
title	Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction
title_short	Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction
title_full	Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction
title_fullStr	Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction
title_full_unstemmed	Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction
title_sort	factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/c0577a1f5126434c87d11c23fcd30f3d
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Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction

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