PREDILATION BALLOONING IN HIGH THROMBUS LADEN STEMIS: AN INDEPENDENT PREDICTOR OF SLOW FLOW/NO-REFLOW IN PATIENTS UNDERGOING EMERGENT PERCUTANEOUS CORONARY REVASCULARIZATION

Background: ST-segment elevation myocardial infarction (STEMI) is a critical presentation of acute myocardial infarction. Primary percutaneous coronary intervention (pPCI) is the recommended treatment to restore forward blood flow. However, the occurrence of slow-flow/no-reflow (SF/NR) can limit optimal reperfusion, affecting patient outcomes. Among various factors, high thrombus burden (≥4 grade) has been linked to SF/NR.Objective: This study evaluates the impact of predilation ballooning on the incidence of intraprocedural SF/NR during primary PCI in patients with high thrombus burden.Material and Methods: This cross-sectional study was conducted at the Department of Cardiology, Federal Govt Polyclinic Hospital, Islamabad, between August 2020 and July 2021. A total of 250 STEMI patients undergoing pPCI with angiographic evidence of high thrombus burden (≥4 grade) were included. Patients were divided into two groups based on the use of predilation ballooning (n = 125 each). Propensity score matching ensured comparability of clinical profiles. Data analysis was performed using IBM SPSS, with p ≤ 0.05 considered statistically significant.Results: Patients in the ballooning group exhibited older age, longer ischemic times, higher heart rates, and more advanced Killip class at presentation. They also had a greater prevalence of diabetes, multivessel disease, and complex coronary anatomy. Predilation ballooning significantly increased the incidence of SF/NR (41.3% vs. 27.4%, p < 0.001). Despite achieving similar final TIMI III flow rates, the ballooning group experienced higher in-hospital mortality (8.1% vs. 4.1%, p = 0.018) and a trend toward increased contrast-induced nephropathy.Conclusion: Predilation ballooning is an independent predictor of intraprocedural SF/NR and is associated with higher in-hospital mortality in STEMI patients with high thrombus burden. These findings emphasize the need to avoid predilation ballooning and minimize procedural hardware to optimize outcomes in this high-risk population.