Long-Term Clinical Outcomes of Transient and Persistent No Reflow Phenomena following Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction.
10.4070/kcj.2016.46.4.490
- Author:
Min Chul KIM
1
;
Jae Yeong CHO
;
Hae Chang JEONG
;
Ki Hong LEE
;
Keun Ho PARK
;
Doo Sun SIM
;
Nam Sik YOON
;
Hyun Joo YOUN
;
Kye Hun KIM
;
Young Joon HONG
;
Hyung Wook PARK
;
Ju Han KIM
;
Myung Ho JEONG
;
Jeong Gwan CHO
;
Jong Chun PARK
;
Ki Bae SEUNG
;
Kiyuk CHANG
;
Youngkeun AHN
Author Information
1. Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea. cecilyk@hanmail.net
- Publication Type:Multicenter Study ; Original Article
- Keywords:
Myocardial infarction;
No-reflow phenomenon;
Percutaneous coronary interventions
- MeSH:
Follow-Up Studies;
Heart Failure;
Humans;
Incidence;
Mortality;
Myocardial Infarction*;
No-Reflow Phenomenon;
Percutaneous Coronary Intervention*;
Stents;
Thrombosis
- From:Korean Circulation Journal
2016;46(4):490-498
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND OBJECTIVES: There is limited information on the transient or persistent no reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: The study analyzed 4329 patients with AMI from a Korean multicenter registry who underwent PCI using coronary stents (2668 ST-elevation and 1661 non-ST-elevation myocardial infarction [MI] patients): 4071 patients without any no reflow, 213 with transient no reflow (no reflow with final thrombolysis in myocardial infarction [TIMI] flow grade 3), and 45 with persistent no reflow (no reflow with final TIMI flow grade≤2). The primary endpoint was all-cause mortality during 3-year follow-up. We also analyzed the incidence of cardiac mortality, non-fatal MI, re-hospitalization due to heart failure, target vessel revascularization, and stent thrombosis. RESULTS: The persistent no reflow group was associated with higher all-cause mortality (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.08-3.65, p=0.028) and cardiac mortality (HR 3.28, 95% CI 1.54-6.95, p=0.002) compared with the normal reflow group. Transient no reflow increased all-cause mortality only when compared with normal reflow group (HR 1.58, 95% CI 1.11-2.24, p=0.010). When comparing transient and persistent no reflow, persistent no reflow was associated with increased all-cause mortality (46.7 vs. 24.4%, log rank p=0.033). CONCLUSION: The persistent no reflow phenomenon was associated with a poor in-hospital outcome and increased long-term mortality mainly driven by increased cardiac mortality compared to the transient no reflow phenomenon or normal reflow.
