BACKGROUND:Compromise of the side branch (SB) during percutaneous coronary intervention (PCI) of bifurcation lesions is challenging. AIMES:This study aims to evaluate the safety and effectiveness of the novel modified JBT, which uses full nominal pressure in the SB balloon while stenting the main vessel (MV) in patients. METHODS:This single-center, prospective study included 74 patients with significant bifurcation lesions undergoing PCI. The method consisted of simultaneously inflating both the MV stent and the SB balloon (at nominal pressure), with balloon sizes customized to the SB diameter (ranging from 2.0 to 2.5 mm, with an ostial length of 10 mm or less). Outcomes including major adverse cardiac events (MACE), target vessel revascularization (TVR), SB patency, and overall procedural success, with a follow-up period of 12 months. RESULTS:All procedures were technically successful, with no balloon entrapment or need for SB stenting. Among all patients, 4.1% experienced dissection of the side branch, but none of these cases resulted in flow limitation. There were no incidences of MACE, TVR, or periprocedural myocardial infarction. Final TIMI 3 flow was observed in 100% of cases. EF improved in 16.2% of patients without deterioration in any case. Final kissing balloon inflation was rarely required (2.7%), and double stenting was needed in only 1.4% of cases. CONCLUSIONS:This novel modified JBT demonstrated high safety and effectiveness in protecting side branches, with no MACE or TVR reported. We suggest that it's a practical, reproducible method for bifurcation PCI, especially in cases involving small or short side branches.

BACKGROUND:Severe aortic stenosis (AS) is commonly associated with advanced cardiac damage, including right ventricular dysfunction (RVD), pulmonary hypertension (PH) and tricuspid regurgitation (TR), which may worsen prognosis after transcatheter aortic valve implantation (TAVI). This systematic review and meta-analysis aimed to assess the effect of these conditions on short-term and mid-term mortality and rehospitalisation following TAVI. METHODS:We conducted a systematic search of PubMed, Scopus and Web of Science for studies published up to June 2025. Eligible studies included adults with AS undergoing TAVI and reported outcomes at 1 month, 6 months or 12 months stratified by the presence of RVD, PH or TR. Studies had to report either HRs, risk ratios (RRs) or sufficient raw event data for mortality or rehospitalisation. Data were synthesised using a random-effects meta-analysis. Subgroup analyses were conducted by cardiac damage severity according to the Généreux staging system and stratified by valve type and diagnostic modality. Risk of bias in included studies was assessed using the Joanna Briggs Institute's checklist for cohort studies. Meta-regression was performed to explore sources of between-study heterogeneity. RESULTS:A total of 34 studies including 26 076 patients met inclusion criteria. Twelve-month HRs for all-cause mortality increased with advancing cardiac damage: borderline stage HR 1.61 (1.22-2.12), stage 3 HR 2.06 (1.63-2.60) and stage 4 HR 2.77 (2.11-3.64). RRs followed a similar trend. Cardiovascular mortality was highest in stage 4 (HR 3.13 (1.20-8.17); RR 2.63 (1.54-4.47)). Rehospitalisation data were limited but suggested elevated risk in stage 3 (RR 1.33 (1.12-1.58)). Meta-regression indicated that age, sex and comorbidities contributed to between-study heterogeneity, particularly in stage 3 analyses. CONCLUSION:Extravalvular cardiac damage, especially RVD (stage 4), is strongly associated with increased short-term and mid-term mortality and rehospitalisation after TAVI. Even borderline-stage patients face elevated risk, underscoring the continuous nature of AS-related cardiac injury. Incorporating cardiac damage staging into preprocedural assessment can enhance risk stratification and guide management to improve patient outcomes. PROSPERO REGISTRATION NUMBER:CRD420250638838.

Background and Aims:Our objective is to report our single-center experience with the novel balloon-expandable Myval Transcatheter Heart Valve (THV) system in Transcatheter Aortic Valve Replacement (TAVR) procedures. Methods:We conducted a retrospective study on a cohort of consecutive patients who underwent TAVR utilizing Myval THV from September 2021 to August 2023 at a tertiary care cardiac center. We collected baseline characteristics, pre- and post-procedural echocardiographic findings, procedural details, in-hospital outcomes, VARC-3 technical success, and complications. Additionally, patients were followed up for 3 months concerning their clinical outcomes. Results:The study population comprised 92 TAVR patients with a mean age of 76.8 ± 7.3 years, 66.3% were male, and the mean STS score was 5.9 ± 3.2%. The most common valve sizes used were 24.5 mm (30.4%), 23 mm (26.1%), and 27.5 mm (17.4%). Pre-dilation was performed in 32 cases (34.8%), achieving a 93.5% technical success rate. In-hospital mortality occurred in three patients (3.3%), which included one annulus rupture. Permanent pacemaker implantation was required in six patients (6.5%). Three patients (3.3%) exhibited 3+ paravalvular leakage demonstrated by angiography. The New York Heart Association (NYHA) functional class showed significant improvement from baseline to discharge (p < 0.0001). At the 3-month follow-up, five patients encountered mortality (5.4), and three experienced an episode of stroke or transient ischemic attack (3.2%). Two other patients were hospitalized due to cardiovascular events during the 3-month follow-up. Conclusion:The Myval THV shows a favorable safety and efficacy profile in TAVR, with low mortality and complications at 3 months.

To evaluate the feasibility, safety, and short-term outcomes of transcatheter closure of sinus venosus atrial septal defect (SVASD) using covered stents. We conducted an institutional retrospective analysis of 24 consecutive patients aged 15-70 years with superior SVASD and significant left-to-right shunting (QP/QS ≥ 1.5), who underwent percutaneous closure using covered stents between June 2021 and December 2023. Pre-procedural imaging included transesophageal echocardiography and cardiac Computed Tomography angiography (CTA). Procedural details, technical success, and echocardiographic parameters were recorded. Post-procedural outcomes were assessed with transthoracic echocardiography and/or CTA. The Patients' median age was 38 years (IQR: 28-53), and 50% were female. Median Atrial Septal Defect (ASD) size was 15 mm (IQR: 11-19), and median QP/QS ratio decreased from 1.8 (IQR: 1.7-1.95) to 1.1 (IQR: 1.0-1.25) after closure (p < 0.001). Covered stents were used in all cases, and 13 patients (54.1%) required additional non-covered stent support. Technical success was achieved in 96% of patients, with one case of device embolization requiring surgical intervention. Minor complications occurred in 7 patients (29.1%), including hematoma and asymptomatic thrombosis. No mortality was observed. At 3 months, right ventricular dysfunction and enlargement significantly improved (p = 0.004 and p = 0.001, respectively), while right atrial size remained unchanged (p = 0.317). Catheter-based repair of SVASD is feasible, safe, and effective with a low rate of complications. This approach may offer a minimally invasive alternative to surgery in anatomically suitable patients.

BACKGROUND:Atrial septal defect (ASD) is a common congenital heart anomaly causing a significant hemodynamic burden if untreated. Transcatheter closure is a minimally invasive standard treatment, but prospective data on short-term cardiac remodeling are limited. AIMS:To evaluate short-term echocardiographic changes in cardiac structure and function following transcatheter ASD closure in adults. METHODS:This prospective observational cohort study included 112 patients aged 15-68 years who underwent transcatheter ASD closure. Comprehensive echocardiography was performed pre-procedure and at 1 and 6 months postprocedure. Parameters assessed included right and left ventricular dimensions, atrial volumes, right ventricular systolic pressure (RVSP), pulmonary artery pressure (PAP), tricuspid regurgitation (TR) severity, and right ventricular ejection fraction (RVEF). RESULTS:Significant reductions in right atrial volume index (RAVI) by 4.5 ± 5.19 mL/m², right ventricular internal diameter, RVSP by 6.8 ± 9.44 mmHg, PAP decreased by 6.46  ±  8.50 mmHg, and TR severity were observed at 6 months (all p < 0.05). Left ventricular dimensions and ejection fraction remained stable, indicating preserved left-heart function. RVEF improved in 31% of patients by 6 months. Cardiac rhythm remained unchanged. Notably, reverse remodeling magnitude and timing were independent of baseline ASD size. CONCLUSION:Transcatheter ASD closure results in early and sustained right-heart reverse remodeling and pulmonary pressure reduction, without adverse effects on left ventricular function or cardiac rhythm. These consistent benefits, regardless of defect size, support the safety and efficacy of this minimally invasive intervention.

Introduction: For those with ST-segment myocardial infarction (STEMI), therapeutic delays are the leading cause of mortality. Contacting a health-care provider takes longer than the emergent prehospital system, the patient referral process, the emergency room, and within the hospital. In our nation's various cities, we aimed to compare these variables. Methods: In the Iranian cities of Sanandaj and Tehran, the Rajaie Cardiovascular Medical and Research Center (RHC) and Tohid Hospital, respectively, undertook this multicenter, multiprefectural, cross-sectional study between 2016 and 2020. Baseline characteristics were gathered from medical records, including age, sex, and employment. In two centers, the first medical contact-to-door (FTD) and door-to-balloon (DTB) times as well as electrocardiographic abnormalities, adjunctive therapy, causal lesions, and FTD and DTB times were evaluated. Results: The study population consisted of 600 STEMI patients, 300 from each institutions. Most of the participants were male, approximately a third of the patients arrived at the hospital using emergency medical service, the most frequent culprit artery in both hospitals was the left anterior descending artery, the average FTD was 333 min in Tehran and 151 min in Sanandaj, with the statistical significance difference (P < 0.001), DTB was significantly lower at RHC than at Tohid Hospital (54.8 min vs. 88.3 min; P < 0.001), the maximum FTD was observed among patients older than 70-year-old (284.72 min). Conclusion: Preparing sufficient facilities for primary percutaneous coronary intervention units, increasing the number of specialists and ensuring their permanent presence in hospitals, and providing health-care personnel with improved training may play significant roles in minimizing DTB.

Objective: To elucidate the value of gated SPECT-MPI using CT attenuation correction (AC) for prediction of pulmonary hypertension (PHT) in coronary patients by estimation of reliability of non-contrast CT in measurement of main pulmonary artery diameter (MPAd) as well as by assessment of potential predictive role of gated parameters as beneficial accessory findings. Background: Contrast-enhanced CT is known as an accurate tool for assessment of MPAd to predict PHT. [1] The low-dose non-contrast CT which is used for AC in MPI study, however, has an unclear value in precise vascular diameter measurement; it is also uncertain whether gated parameters could help to predict PHT. Methods and patients: A total of 207 patients, who had a transthoracic echocardiography and MPI with an interval of maximum one month, underwent this retrospective study. PHT was defined as a RVSP >= 36 mmHg by echocardiography; peak tricuspid regurgitation velocity (PTRV) was also calculated to use as a criterion for PHT. Of all subjects, 120 had RVSP >= 36 and 87 showed RVSP < 36; there also were 191 and 16 patients with PTRV <= 3.4 m/s and > 3.4 m/s, respectively. Comparison was made unconnectedly between each group regarding the echocardiography results with the MPI parameters, with and without CT-AC, including MPAd derived from CT as well as RV/LV uptake ratio, shape index and septal wall motion and thickening scores to define the best indicators of PHT. Results: There was a significant association between established benchmark of PHT in echocardiography (RVSP), with MPAd derived from non-contrast CT as well as with LV shape index from gated study and RV/LV uptake ratio acquired from non-AC SPECTMPI. Also, stress and rest RV/LV uptake ratio, MPAd, LV end-systolic and LV enddiastolic shape indexes are significantly higher in patients with RVSP >= 36 mmHg compare to patients with RVSP < 36 mmHg. Conclusions: Gated-SPECT-MPI using CT-AC can predict PHT by reliable estimation of MPAd as well as by defining RV/LV uptake ratio and shape index, providing an added clinical value for this invaluable modality in cardiac patients.

Background: The noninvasive estimation of elevated left ventricular end-diastolic pressure (LVEDP) is a critical step in assessing left ventricular diastolic dysfunction (LVDD). Nonetheless, most echocardiographic parameters currently used for this purpose have significant limitations. Recent studies have highlighted the utility of left atrial (LA) strain as a noninvasive method for estimating LVEDP. This study aimed to explore the correlations between LA deformation parameters, measured using speckle-tracking echocardiography (STE), and invasively obtained LVEDP. Methods: This prospective study involved 82 patients in sinus rhythm who underwent left heart catheterization at our center. All participants underwent comprehensive transthoracic echocardiography and peak atrial longitudinal strain (PALS) assessment via STE within 12 hours before catheterization. Results: LVEDP was elevated in 45 patients (54.9%) and normal in 37 (45.1%). PALS, LA ejection fraction, and septal E’ showed moderate inverse correlations with LVEDP (r= −0.590, P=0.001; r= −0.463, P=0.001; and r= −0.449, P=0.001, respectively). The E/E’ ratio also exhibited a moderate correlation with LVEDP (r=0.567, P=0.001). Lateral E’ and the E/A ratio demonstrated weaker inverse correlations with LVEDP (r= −0.231, P=0.037 and r= −0.229, P=0.038, respectively). In multivariate logistic regression analysis, age (OR, 1.14, 95% CI, 1.02 to 1.27), PALS (OR, 0.77, 95% CI, 0.65 to 0.91), and the E/E’ ratio (OR, 1.36, 95% CI, 1.11 to 1.89) were identified as independent predictors of an LVEDP≥12 mm Hg. PALS demonstrated the highest diagnostic accuracy for predicting an LVEDP≥12 mm Hg, with an AUC of 0.849 (95% CI, 0.764 to 0.935; P<0.001). A PALS cutoff value of 35% yielded a sensitivity of 81.1% and a specificity of 81.4% for predicting elevated LVEDP. Conclusion: PALS emerged as a reliable noninvasive parameter for predicting elevated LVEDP. Its application may facilitate the earlier identification of LVDD.

We compared chorioretinal microvascular of Slow Coronary Flow Phenomenon (SCFP) patients using Optical Coherence Tomography Angiography (OCTA) to healthy controls. We recruited 21 patients from September 2023 until January 2024 from two referral centers. We enrolled 21 age-sex-matched controls retrospectively. Patients were referred to obtain OCTA in our outpatient ophthalmology clinic. The OCTA and Enhanced Depth Imaging (EDI) OCT findings were measured. Whole image and perifoveal Vascular Density (VD) of superficial and deep capillary plexuses and Parafoveal VD of superficial layer were diminished in SCFP groups compared to controls (p < 0.05) while both superficial and deep foveal VD and deep parafoveal VD were spared. Sub-Foveal Choroidal Thickness (SFCT) was significantly thinned compared to controls (p < 0.05), while central macular thickness, choroidal vascularity index, and choriocapillaris flow were similar between groups. SFCT was the only independent predictor of SCFP on multivariable regression analysis. Parafoveal superficial VD and SFCT showed the strongest ability to distinguish between SCFP patients and healthy controls (AUC: 0.80, 0.79, respectively). Additionally, whole image and perifoveal VD in both superficial and deep capillary plexus demonstrated at least moderate discriminatory power. We found that decreased retinal microvascular density may serve as a potential biomarker for the diagnosis of SCFP. Additionally, SCFP patients had considerably thinner SFCTs than controls. Parafoveal superficial VD and SFCT showed the highest potential in distinguishing between individuals with SCFP and healthy individuals. SCFP is likely linked to anomalies in the small blood vessels of the retina and choroid. However, further studies are needed to confirm this association and to control for the potential confounding effects of diabetes and hypertension.

Background:The radial approach is now recommended as the default strategy in diagnostic coronary angiography and percutaneous coronary intervention. Radial artery occlusion (RAO) is the most common complication that limits subsequent angiographic procedures through this access. Recently, distal radial access (DRA) has been recommended as an alternative access site. Despite lower RAO rates in DRA in some recent clinical trials, concerns remain regarding possible complications and limitations due to the small size of the distal radial artery. Objective:The present study aimed to compare traditional radial access (TRA) and DRA concerning RAO in percutaneous coronary procedures. Methods:In the present prospective cohort study, percutaneous coronary procedures were performed via DRA or TRA in 2 study groups. All consecutive participants underwent DRA from September 2021 to March 2022 and TRA from April 2022 to June 2022. Ultrasonography was performed preprocedurally in the DRA group, and patients with small distal artery diameters (<2 mm) were excluded. The same 6-Fr sheaths and standard air-filled compression devices were used in both groups. The primary endpoint was RAO in ultrasound sonography on the first postprocedural day, and the secondary endpoints were the success rate, access time, angiography time, radial artery spasms, and vascular access complications. Results:A total of 298 patients were assigned to the DRA group and 278 to the TRA group. The RAO rate was significantly higher in the TRA group than in the DRA group (10.1 % vs 0.9 %; P = 0.0001; OR, 0.08, 95 % CI, 0.01-0.27). The success rate was significantly higher in the TRA group (96 % vs 90.2 %; P = 0.009). Access crossovers were done on 12 patients (4.0 %) in the TRA group and 24 patients (9.8 %) in the DRA group (P < 0.001). The mean access time was significantly lower in the TRA group than in the DRA group (1.9 min vs 2.9 min; P < 0.001). The mean angiography time did not significantly differ between the groups (10.2 min in the TRA group vs 9.9 min in the DRA group). The rate of radial artery spasms was not significantly different between the 2 groups (13.8 % in the TRA group vs 14.5 % in the DRA group). The rates of access site hematoma (12.4 % vs 2.3 %; P < 0.001) and bleeding (10.7 % vs 4.1; P = 0.005) were significantly higher in the TRA group. Conclusions:DRA was safe and feasible with lower rates of RAO and access site complications than TRA. Thus, it could be used as an alternative approach in percutaneous coronary procedures. However, the trade-off for these advantages of DRA is an increase in cross-over rate, and a decrease in puncture success rate.

Takayasu Arteritis (TA) is a chronic idiopathic granulomatous pan-arteritis affecting the pulmonary artery, the aorta, and its principal derived branches. The majority of TA patients are female (82.9%-97.0%). Due to the inflammatory character of the illness, arterial stenosis therapy must be treated differently than the atherosclerosis process. In this review paper, we outline a strategy using real-world challenging cases.

Background The aim of the current study is to assess the prevalence of different categories of thyroid dysfunction and their associated risk factors among the modern urban population of Tehran, the capital of Iran. Methods The present investigation is a sub-study of the HAMRAH study, a population-based prospective study designed to assess the prevalence of traditional cardiovascular risk factors and their changes through a 10-year follow-up. 2228 (61% female) adults aged between 30 and 75 years old and with no overt cardiovascular diseases were selected through a multistage cluster randomized sampling. Blood levels of thyroid-stimulating hormone (TSH), thyroxin (T4), and triiodothyronine (T3) were measured with the aim of assessing the prevalence of abnormal thyroid function status among the modern urban Iranian population, and in order to report the total prevalence of participants with clinical hypo- or hyperthyroidism, the number of individuals taking thyroid-related drugs were added to the ones with overt thyroid dysfunction. A subgroup analysis was also performed to determine the associated risk factors of thyroid dysfunction. Results The prevalence of thyroid dysfunction among the total population was 7% (95%CI: 5.9 − 8%) and 0.4% (95% CI: 0.1 − 0.6%) for subclinical and overt hypothyroidism, and 1.6% (95% CI: 1 − 2%) and 0.2% (95% CI: 0 − 0.3%) for subclinical and overt hyperthyroidism, respectively. Clinical thyroid dysfunction was detected in 10.3% of the study population (9.4% had clinical hypo- and 0.9% had clinical hyperthyroidism). In the subgroup analysis, thyroid dysfunction was significantly more prevalent among the female participants ( P -value = 0.029). Conclusions In the current study, the prevalence of different categories of abnormal thyroid status, and also the rate of clinical hypo- and hyperthyroidism was assessed using the data collected from the first phase of the HAMRAH Study. In this study, we detected a higher prevalence of clinical and subclinical hypothyroidism among the Iranian population compared to the previous studies.

OBJECTIVES:Chronic venous disease (CVD) of the lower extremities is one of the common venous diseases in different populations, with a wide range of clinical manifestations and undetermined exact prevalence owing to different population characteristics and measurement methods. This study aimed to estimate the prevalence of CVD among the modern Iranian urban population and determine its associated risk factors. METHODS:The Heart Assessment and Monitoring in Rajaie Hospital study, a longitudinal population-based cohort, aims to investigate the baseline prevalence and the 10-year incidence of cardiovascular diseases and associated risk factors in the adult population aged 30 to 75 years with no overt cardiovascular diseases in Tehran. Two instructed interventional cardiologists performed CVD evaluation using the Clinical-Etiology-Anatomy-Pathophysiology classification. CVD was graded as C1 to C6, and chronic venous insufficiency (CVI) as C3 to C6. A multivariable regression model was used to analyze the association between CVD and prespecified covariates of age, sex, body mass index (≥30 kg/m2), smoking, hypertension, diabetes mellitus, physical activity, dyslipidemia, and delivery method. RESULTS:CVD prevalence among 1176 participants was 36.5% (95% confidence interval [CI], 33.8-39.3) and was higher in women than men (44.2% vs 23.5%). CVI prevalence was only 0.7% (95% CI, 0.3-1.3). Multivariable analysis showed that advanced age (odds ratio [OR], 1.06; 95% CI, 1.04-1.08), female sex (OR, 2.98; 95% CI, 2.14-4.14), and body mass index of ≥30 (OR, 1.36; 95% CI, 1.03-1.81) were independently associated with CVD. Physical activity (OR, 0.77; 95% CI, 0.58-1.02) was nearly protective, whereas other factors, including traditional cardiovascular risk factors, had no meaningful association with CVD. CONCLUSIONS:Our findings showed that CVD was prevalent in the modern Iranian urban population. However, considering the very low prevalence of the higher stages of the disease, the benefit of mass screening is debatable, and better risk discriminators should be investigated.

Post-myocardial infarction ventricular septal rupture is the most catastrophic mechanical complication with high morbidity and mortality, reaching 94% in patients treated conservatively and 47% in patients undergoing cardiac surgery procedures (30-day mortality). In this review article we tried to review trans-catheter closure approach and explain elaborately device selection based on real-world patients in this fatal complication.

Regarding to more invasive treatment of atrial arrhythmia (atrial fibrillation ablation) and pulmonary vein isolation (PVI), the rate of acquired pulmonary vein stenosis (PVS) is increasing and at present, PV ablation for AF has become the principal cause of PVS in adult patients. On the other way, by improvement in procedural techniques, equipment, and the experience of the operators, the incidence of PVS has been decreased. There is some controversy about the manner of follow-up of these patients and in most centers, just symptomatic patients are considered for imaging and treatment. Almost always, those with PV stenosis more than 70% or multiple PV involvement become symptomatic and if give them up without treatment, pulmonary symptoms and finally irreversible pulmonary hypertension will occurred. So, intensive pursue after the procedure is highly recommended. Whereas in pediatric patients with congenital or acquired PVS, the best treatment approach is surgery, in adult patients, the preferred type of treatment is the transcatheter intervention with high acute success rate. In this present review, we have scrutinized about the diagnostic modalities, the indications for intervention, the diverse treatment strategies, and principally clarify an accurate stepwise approach during transcatheter procedure.

Coronary artery fistulas (CAFs) are accounted as the most congenital coronary anomalies. As their natural course is progressive dilatation of the feeder arteries and the fistula tract, so, catastrophic complications are frequently illustrated by aging. Even in those with asymptomatic small fistulas, close follow-up is mandatory to prevent subsequent sequelas. In patients with medium or large-sized fistulas, irrespective of symptoms, closure (either by surgical ligation or transcatheter closure) is recommended. In the current era of advances in the equipment and devices and also innovations in percutaneous closure techniques and preprocedural imaging, TCC is now regarded as the preferred strategy for CAF closure except in some high-risk cases. So, by appropriate case selection modalities, pre-procedural planning, and determining the closure techniques, recent small case-series studies have been reported good final angiographic and clinical results by TCC. In this article, we have introduced several transcatheter closure techniques by details; also, we have recommended more multi-center trials with long-term clinical follow-up to address the best treatment options in these patients.

Background:Limited data exist on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) presenting with ST-segment-elevation myocardial infarction (STEMI).Methods:This multicenter study, conducted in 6 centers in Iran, aimed to compare baseline clinical and procedural data between a case group, comprising STEMI patients with COVID-19, and a control group, comprising STEMI patients before the COVID-19 pandemic, and to determine in-hospital infarct-related artery thrombus grades and major adverse cardio-cerebrovascular events (MACCEs), defined as a composite of deaths from any cause (cardiovascular and noncardiovascular), nonfatal strokes, and stent thrombosis.Results:No significant differences were observed between the 2 groups regarding baseline characteristics. Primary percutaneous coronary intervention (PPCI) was performed in 72.9% of the cases and 98.5% of the controls (P=0.043), and primary coronary artery bypass grafting was performed in 6.2% of the cases and 1.4% of the controls (P=0.048). Successful PPCI procedures (final TIMI flow grade III) were significantly fewer in the case group (66.5% vs 93.5%; P=0.001). The baseline thrombus grade before wire crossing was not statistically significantly different between the 2 groups. The summation of thrombus grades IV and V was 75% in the case group and 82% in the control group (P=0.432). The rate of MACCEs was 14.5% and 2.1% in the case and control groups, respectively (P=0.002).Conclusion:In our study, the thrombus grade had no significant differences between the case and control groups; however, the in-hospital rates of the no-reflow phenomenon, periprocedural MI, mechanical complications, and MACCEs were statistically significantly higher in the case group.