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: email@example.com
Received January 27, 2014
Received in revised form February 8, 2014
Accepted February 16, 2014