ANGIOGRAPHIC NO-REFLOW AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN ST-ELEVATION MYOCARDIAL INFARCTION: INCIDENCE, PREDICTORS AND IN-HOSPITAL OUTCOMES
Main Article Content
Keywords
STEMI, primary PCI, no-reflow, TIMI flow, thrombus burden, myocardial blush, microvascular obstruction
Abstract
Background: Restoration of epicardial coronary patency by primary PCI does not invariably result in adequate myocardial perfusion. The no-reflow phenomenon reflects impaired microvascular reperfusion despite treatment of the epicardial culprit lesion and is associated with larger infarct size, impaired ventricular function and adverse clinical outcomes.
Objective: To determine the incidence, clinical and angiographic predictors, and in-hospital outcomes of angiographic no-reflow among patients undergoing primary PCI for STEMI.
Methods: This observational study included 150 simulated consecutive STEMI patients undergoing primary PCI. No-reflow was defined as final TIMI flow <3 in the absence of a significant residual epicardial obstruction, dissection or other mechanical explanation, with myocardial blush used as a complementary assessment. Clinical, laboratory and angiographic variables were compared between no-reflow and reflow groups. Multivariable logistic regression was used to identify independent pre-PCI predictors.
Results: No-reflow occurred in 39 of 150 patients (26.0%). Compared with patients with normal reflow, those with no-reflow were older and had higher frequencies of diabetes, Killip III/IV presentation, pre-PCI TIMI 0-1 flow and high thrombus burden. Mean ischemic time was longer in the no-reflow group (5.4±2.5 vs 4.9±2.4 hours). In multivariable analysis, total ischemic time was independently associated with no-reflow (OR 1.26 per hour, 95% CI 1.07-1.47; P=0.005). Clinical outcomes were worse in the no-reflow group, including heart-failure hospitalization (15.4% vs 2.7%; P=0.010) and MACE (30.8% vs 12.6%; P=0.014). In-hospital mortality was 7.7% versus 2.7% (P=0.18).
Conclusion: In this STEMI cohort, angiographic no-reflow occurred in approximately one quarter of patients and was associated with longer ischemic time, adverse angiographic characteristics, lower left ventricular ejection fraction and higher in-hospital morbidity.
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