Coronary Artery Disease

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Coronary Artery Disease:
doi: 10.1097/MCA.0000000000000108
Original Research

The impact of no-reflow phenomena after primary percutaneous coronary intervention: a time-dependent analysis of mortality

Choo, Eun Hoa; Kim, Pum Joona; Chang, Kiyuka; Ahn, Youngkeuni; Jeon, Doo Sooc; Lee, Jong Mind; Kim, Dong Binb; Her, Sung-Hoe; Park, Chul Soof; Kim, Hee Yeolg; Yoo, Ki-Dongh; Jeong, Myung Hoi; Seung, Ki-Baea

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Abstract

Background: The no-reflow phenomenon is a potential complication of primary percutaneous coronary intervention (PCI). Predictors of the no-reflow phenomenon and the impact on long-term mortality remain unclear.

Methods: Two thousand and seventeen patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary PCI were consecutively enrolled in the multicentre Acute Myocardial Infarction registry of Korea. The no-reflow phenomenon was diagnosed on the basis of angiographic criteria. The primary outcome was all-cause mortality.

Results: The no-reflow phenomenon was diagnosed in 262 patients (13.0%). Independent predictors of no-reflow were older age, high Killip class, reduced pre-PCI thrombolysis in myocardial infarction flow grade, and longer stent length in the culprit vessel. During a median follow-up period of 4.1 years (interquartile range: 3.0–5.2 years), patients with no-reflow showed a higher rate of mortality than that observed in patients with reflow (30.2 vs. 18.3%, P<0.001). The multivariate Cox proportional hazards model identified the no-reflow phenomenon as an independent correlate of long-term mortality [adjusted hazard ratio (HR): 1.45; 95% confidence interval (CI): 1.12–1.86; P=0.004]. Time period-specific analyses demonstrated that the association between no-reflow and mortality was significant and stronger for short-term (<30 days) mortality (adjusted HR: 3.11; 95% CI: 1.91–5.05; P<0.001) but was not significant for longer-term mortality (≥30 days; adjusted HR: 1.12; 95% CI: 0.82–1.52; P=0.47).

Conclusion: In patients with STEMI who had undergone primary PCI, the no-reflow phenomenon was an independent predictor of short-term but not long-term mortality.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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