Clinical and procedural predictors of no-reflow phenomenon after primary percutaneous coronary interventions: experience at a single center

The aim of the study was to identify clinical factors, angiographic findings, and procedural features that predict no-reflow phenomenon (Thrombolysis In Myocardial Infarction (TIMI) flow grade < or =2) in patients with acute myocardial infarction (AMI) who undergo primary percutaneous coronary in...

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Published in:Circulation journal : official journal of the Japanese Circulation Society Vol. 72; no. 5; p. 716
Main Authors: Kirma, Cevat, Izgi, Akin, Dundar, Cihan, Tanalp, Ali Cevat, Oduncu, Vecih, Aung, Soe Moe, Sonmez, Kenan, Mutlu, Bulent, Ozdemir, Nihal, Erentug, Vedat
Format: Journal Article
Language:English
Published: Japan 2008
Subjects:
Adult
Aged
Angioplasty, Balloon, Coronary
Coronary Angiography
Coronary Circulation
Coronary Thrombosis - diagnostic imaging
Coronary Thrombosis - therapy
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - diagnostic imaging
Myocardial Infarction - therapy
Predictive Value of Tests
Prospective Studies
Treatment Failure
ISSN:1346-9843
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Summary:The aim of the study was to identify clinical factors, angiographic findings, and procedural features that predict no-reflow phenomenon (Thrombolysis In Myocardial Infarction (TIMI) flow grade < or =2) in patients with acute myocardial infarction (AMI) who undergo primary percutaneous coronary intervention (PCI). A series of 382 consecutive patients with AMI underwent primary PCI within 12 h of symptom onset. Patients with ischemic symptoms continuing for more than 12 h were also included. Clinical, angiographic and procedural data were collected for each subject. Ninety-three (24.3%) of the patients developed no-reflow phenomenon, and their findings were compared with those of the reflow group. Univariate analysis showed that advanced age (>60 years), delayed reperfusion (> or =4 h), low (< or =1) TIMI flow prior to PCI, cut-off type total occlusion, high thrombus burden on baseline angiography, long target lesion (>13.5 mm) and large vessel diameter all correlated with no-reflow (p<0.05 for all). Multiple logistic regression analysis identified that advanced age (odds ratio (OR) 1.04, p=0.001), delayed reperfusion (OR 1.4, p=0.0004), low TIMI flow before primary PCI (OR 1.1, p=0.0002), target lesion length (OR 5.1, p=0.0003) and high thrombus burden (OR 1.6, p=0.03) on angiography as independent predictors of no-reflow phenomenon. The occurrence of no-reflow phenomenon after primary PCI can be predicted using simple clinical, angiographic and procedural features. In this selected group of patients, adjunctive pharmacotherapy and/or distal protection device may be of value.
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ISSN:1346-9843
DOI:10.1253/circj.72.716