Primary percutaneous coronary intervention
bleeding, thrombus, hemorrhagic stroke
BLEEDING, THROMBUS, HEMORRHAGIC STROKE
Primary PCI was performed using 6-Fr guiding catheters via radial or femoral arterial approaches. Patients were anticoagulated with a heparin bolus (70–100 U/kg) administered either intravenously, or directly into the coronary artery via the guiding catheter. The route of heparin administration was up to the discretion of the operator and was recorded prospectively. Two interventional cardiologists blinded to treatment allocation and study data independently assessed angiographic variables such as the TIMI flow score at baseline and at the completion of the primary PCI procedure. The treating operator independently determined whether to pursue balloon pre-dilatation stenting (balloon pre-dilatation followed by stenting) or direct stenting (stenting without balloon pre-dilatation). In accordance with standard procedural practices, all patients in both groups underwent post-dilation following stent implantation. This routine step ensures optimal stent apposition and expansion, minimizing the risks associated with potential stent under-expansion or malapposition. Iopromide (Ultravist, Bayer HealthCare Pharmaceuticals, Leverkusen, Germany) was used as the contrast agent. The study team documented information such as stent diameter and length, maximum inflation pressure, and the amount of contrast agent. The decision to use an aspiration catheter (Thrombuster II manual thrombus aspiration catheter, Kaneka Inc., Osaka, Japan) during the primary PCI was determined by the treating physician and was prospectively documented. Per institutional guidelines, an intracoronary glycoprotein IIb/IIIa inhibitor was administered if a TIMI flow score of 3 was not achieved after epicardial revascularization of the culprit artery during the initial presentation with STEMI. Relative contraindications included age > 80 years, a low hemoglobin, history of hemorrhagic stroke or bleeding requiring blood transfusion; the decision to administer glycoprotein IIb/IIIa inhibitor was ultimately determined by the treating physician and prospectively documented.