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Published on: May 28, 2019
Prediction of no-reflow phenomenon in patients treated with primary percutaneous coronary intervention for ST-segment
Li Yang1, Hongliang Cong1, Yali Lu2
1Department of Cardiology, Tianjin Chest Hospital.
Insights
A new risk scoring system effectively identifies patients with ST-segment elevation myocardial infarction (STEMI) at high risk for no-reflow complications after percutaneous coronary intervention (PCI). This tool aids in predicting and managing this common adverse event.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- No-reflow is a significant complication following percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
- Predicting and mitigating no-reflow is crucial for improving patient outcomes after primary PCI.
Purpose of the Study:
- To identify independent risk factors for no-reflow in STEMI patients undergoing PCI.
- To develop and validate a risk scoring system for predicting no-reflow complications.
Main Methods:
- Retrospective analysis of 1658 STEMI patients undergoing direct PCI.
- Development and validation cohorts used to identify risk factors and test a scoring system.
- Multivariate analysis and ROC curve analysis were employed to assess predictive accuracy.
Main Results:
- Key independent risk factors identified include older age (≥65 years), absence of ACE inhibitor/ARB use, poor collateral circulation (
8 mmol/L). - The developed risk scoring system demonstrated moderate predictive accuracy in both development (AUC 0.648) and validation (AUC 0.637) cohorts.
- The system showed acceptable sensitivity and specificity in identifying patients at risk for no-reflow.
Conclusions:
- A novel risk scoring system effectively identifies STEMI patients at high risk of no-reflow during PCI.
- This scoring system can aid clinicians in risk stratification and potentially guide treatment strategies to prevent no-reflow.
- Further prospective studies are warranted to confirm the clinical utility of this risk score.
Abstract:
No-reflow is an important complication among patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).A retrospective study of 1658 STEMI patients undergoing direct PCI was performed. Patients were randomly assigned at a 7:3 ratio into development cohort and validation cohort and into no-reflow and normal blood flow groups. Clinical data and laboratory examinations were compared to identify independent risk factors and establish a no-reflow risk scoring system.In the development cohort (n = 1122), 331 (29.5%) had no-reflow. Multivariate analysis showed age ≥ 65 years (OR = 1.766, 95% confidence interval (CI): 1.313-2.376, P < .001), not using angiotonase inhibitor/angiotensin receptor antagonists (OR = 1.454, 95%CI: 1.084-1.951, P = .013), collateral circulation
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