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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

doi: 10.1097/MCA.0000000000000108
Original Research

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.

aDepartment of Internal Medicine, Division of Cardiology, Cardiovascular Center, Seoul St. Mary’s Hospital

bDivision of Cardiology, St. Paul’s Hospital, Seoul

cDivision of Cardiology, Incheon St. Mary’s Hospital, Incheon

dDivision of Cardiology, Uijeongbu St. Mary’s Hospital, Uijeongbu

eDivision of Cardiology, Daejeon St. Mary’s Hospital, Daejeon

fDivision of Cardiology, Yeouido St. Mary’s Hospital, Yeouido

gDivision of Cardiology, Bucheon St. Mary’s Hospital, Bucheon

hDivision of Cardiology, St. Vincent’s Hospital, The Catholic University of Korea, Suwon

iDivision of Cardiology, Chonnam National University Hospital, Chonnam National University, Gwangju, Korea

Correspondence to Pum Joon Kim, MD, Department of Internal Medicine, Division of Cardiology, Cardiovascular Center, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea Tel: +82 2 2258 1134; fax: +82 2 2258 1138; e-mail:

Received January 27, 2014

Received in revised form February 8, 2014

Accepted February 16, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins