Risk Factors for No-Reflow Phenomenon after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome
Tian Liang1,2, Min Liu1, Chengyu Wu1
1Xuzhou City Hospital of TCM Affiliated to Nanjing University of Chinese Medicine, Xuzhou, Jiangsu Province, China.
Insights
The no-reflow phenomenon after percutaneous coronary intervention affects 16.1% of acute coronary syndrome patients, with independent risk factors including older age, longer reperfusion times, and higher thrombus load.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- The no-reflow phenomenon is a complication following percutaneous coronary intervention (PCI).
- Understanding its risk factors is crucial for managing patients with acute coronary syndrome (ACS).
Purpose of the Study:
- To identify and analyze the independent risk factors associated with the no-reflow phenomenon after PCI in ACS patients.
Main Methods:
- A cohort of 733 acute myocardial infarction patients undergoing emergency PCI were analyzed.
- Patients were categorized into normal reflow and no-reflow groups based on post-PCI TIMI and myocardial blush grading.
- Risk factors were assessed using univariate and multivariate logistic regression analyses.
Main Results:
- The incidence of no-reflow was 16.1%.
- Independent risk factors identified include age > 65 years, reperfusion time > 6 hours, low systolic pressure (< 100 mmHg), preoperative intra-aortic balloon pump use, low TIMI grade (≤ 1) pre-PCI, high thrombus load, and long target lesion.
- Factors like higher troponin and creatine kinase peaks, and preoperative cardiac function Killip grade ≥ 2 were also significant in univariate analysis.
Conclusions:
- The no-reflow phenomenon in ACS patients undergoing PCI is influenced by a complex interplay of pathological factors.
- Identifying these risk factors allows for targeted interventions to improve PCI outcomes.
Background:
To explore risk factors for no-reflow phenomenon after percutaneous coronary intervention in patients with acute coronary syndrome.
Methods:
A total of 733 acute myocardial infarction patients with persistent ischemic chest pain within 12 or 12-24 hours after onset received emergency percutaneous coronary intervention. Patients were divided into a normal reflow group and a no-reflow group, according to TIMI grading and myocardial blush grading after percutaneous coronary intervention. Related risk factors were analyzed.
Results:
The incidence of no-reflow phenomenon after percutaneous coronary intervention was 16.1%. Univariate analysis showed that, compared with the normal reflow group, the no-reflow group was older, reperfusion time was significantly longer, preoperative systolic pressure was lower, troponin peak was higher, and creatine kinase enzyme peak was higher (p < 0.05). The proportions of preoperative cardiac function Killip grade ≥ 2 and number of patients using preoperative intra-aortic balloon pump were significantly different (p < 0.05). Multivariate logistic regression analysis showed that age > 65 years (OR: 1.471; 95% CI: 1.462-1.492; p = 0.007), reperfusion time > 6 hours (OR: 1.274; 95% CI: 1.164-1.405; p = 0.001), low systolic pressure at admission (< 100 mmHg) (OR: 1.918; 95% CI: 1.017-3.897; p = 0.004), intra-aortic balloon pump use before percutaneous coronary intervention (OR: 1.949; 95% CI: 1.168-3.253; p = 0.011), low TIMI grade (≤ 1) before percutaneous coronary intervention (OR: 1.100; 95% CI: 1.086-1.257; p < 0.01), high thrombus load (OR: 1.274; 95% CI: 1.423-2.761; p = 0.030), and long target lesion (OR: 1.948; 95% CI: 1.908-1.990; p = 0.019) were independent risk factors.
Conclusions:
No-reflow phenomenon after percutaneous coronary intervention in patients with acute coronary syndrome was affected by complicated pathological factors.
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