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KMID : 0368120160460040490
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Korean Circulation Journal
2016 Volume.46 No. 4 p.490 ~ p.498
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Long-Term Clinical Outcomes of Transient and Persistent No Reflow Phenomena following Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction
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Kim Min-Chul
Cho Jae-Yeong
Jeong Hae-Chang
Lee Ki-Hong
Park Keun-Ho
Sim Doo-Sun
Yoon Nam-Sik
Youn Hyun-Joo
Kim Kye-Hun
Hong Young-Joon
Park Hyung-Wook
Kim Ju-Han
Jeong Myung-Ho
Cho Jeong-Gwan
Park Jong-Chun
Seung Ki-Bae
Chang Ki-Yuk
Ahn Young-Keun
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Abstract
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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.
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KEYWORD
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Myocardial infarction, No-reflow phenomenon, Percutaneous coronary interventions
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