Clinical Predictors of No-Reflow in Percutaneous Coronary Intervention for Acute Myocardial Infarction

Juan Gagliardi, Jorge Szarfer, Carolina Travetto, Alejandro Garcia Escudero, Gerardo Gigena, Andrea Rodriguez, Analia Alonso, Rodrigo Blanco, Federico Blanco, Ricardo Aquiles Sarmiento, Miguel Angel Riccitelli

Abstract


Background

The no-reflow phenomenon in the setting of primary coronary intervention for acutemyocardial infarction (AMI) is relatively common and is associated with adverse outcomes.The detection of clinical variables associated with this phenomenon beforethe procedure might help to adopt preventive measures and thus improve the results.

Objective

The aim of this study was to identify clinical predictors of the no-reflow phenomenonin the setting of percutaneous coronary intervention for ST-segment elevation acutemyocardial infarction, prior to the procedure.

Methods

A total of 742 patients with AMI < 12 hours since onset of symptoms treated withprimary percutaneous coronary intervention were analyzed. Patients with epicardialTIMI grade 0 flow after the procedure were excluded. No-reflow was considered asthe presence of TIMI grade 1-2 flow immediately after the procedure in the absenceof residual stenosis. Demographic variables, coronary risk factors, family history anddelay to reperfusion were analyzed. Multivariate logistic regression was used to determinethe independent prognostic value of the variables associated with no-reflow.ResultsA total of 675 patients were included. The no-reflow phenomenon was present in 119patients (17.6%). Patients with no-reflow were older (60.8 ± 12 vs. 57.0 ± 11 years;p = 0.0001) and had less prevalence of current smoking (58.8% vs. 67.8%, p = 0.03)and of previous history (22.7% vs. 37.8%, p = 0.0007), with no significant differencesin the rest of coronary risk factors and history of cardiovascular disease. AnteriorAMI (58.8% vs. 43.7%, p = 0.002), heart failure at admission (17.6% vs.10.1%, p= 0.01) and delay to reperfusion (240 [151-360] vs.195 [120-302] minutes, p=0.02)were more frequent in the no-reflow group. Multivariate analysis identified age > 60years, anterior infarction and delay to reperfusion > 3 hours as independent predictorsof no-reflow.ConclusionAdvanced age, anterior infarction and delay to reperfusion were independent clinicalpredictors of no-reflow. The confirmation of these findings in prospective studiesmight allow the implementation of strategies to prevent this phenomenon and eventuallyimprove the long-term clinical outcomes.


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar