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Published on: May 28, 2019
Predictors of no-reflow phenomenon following percutaneous coronary intervention for ST-segment elevation myocardial
P Aggarwal1, L Rekwal2, S K Sinha2
1ABVIMS and Dr RML Hospital, New Delhi, India.
Insights
No-reflow after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is common. Advanced age, longer reperfusion times, and lower ejection fraction predict this adverse outcome.
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Infarction Research
Background:
- No-reflow phenomenon during percutaneous coronary intervention (PCI) is a significant complication in ST-segment elevation myocardial infarction (STEMI) patients.
- While predictors for primary PCI are studied, data on late presenters, who form the majority in peripheral centers, remains limited.
Purpose of the Study:
- To identify clinical, angiographic, and procedural predictors of no-reflow in STEMI patients undergoing PCI within seven days of symptom onset.
- To address the data gap concerning no-reflow predictors in patients with delayed presentation.
Main Methods:
- A single-center prospective case-control study included 958 STEMI patients undergoing PCI within 7 days.
- Baseline and angiographic data were collected, and patients were categorized into reflow and no-reflow groups based on myocardial blush grade (MBG).
Main Results:
- The no-reflow group (18.9% of patients) was characterized by higher mean age, lower admission systolic blood pressure, elevated peak Troponin I, and reduced left ventricular ejection fraction (LVEF).
- Multivariable analysis identified advanced age, reperfusion time > 6 hours, admission SBP < 100 mmHg, Killip class ≥ 3, LVEF ≤ 35%, low initial MBG, long lesion length, large vessel diameter (>3.5mm), and high thrombus burden as independent predictors of no-reflow.
Conclusions:
- The no-reflow phenomenon post-PCI for STEMI is complex and influenced by multiple factors.
- Preprocedural lesion characteristics and early perfusion status are critical determinants of no-reflow outcomes.
Objectives:
No reflow during percutaneous coronary intervention (PCI) is a complex issue with serious outcomes. Multiple studies have studied predictors of no-reflow during primary PCI, but data on patients with the late presentation is sparse, which constitutes the majority of patients in peripheral centers. This study aimed to determine predictors of no-reflow during PCI in patients with ST-segment elevation myocardial infarction (STEMI) in 7 days.
Methods:
It was a single-center prospective case-control study performed at a tertiary care center and included 958 patients with STEMI who underwent PCI within 7 days of symptom onset. Baseline and angiographic data of patients undergoing PCI were recorded and patients divided into reflow and no-reflow group.
Results:
Of 958 who underwent PCI, 182 (18.9%) showed no-reflow by myocardial blush grade (MBG)<2. No-reflow group had a higher mean age (66.46±10.71 vs. 61.36±9.94 years), lower systolic blood pressure (SBP) on admission (100.61±26.66 vs. 112.23±24.35, P<0.0001), a higher level of peak Troponin I level (9.37±2.81 vs. 7.66±3.11ng/dL, P<0.0001), low left ventricular ejection fraction (36.71±3.89 vs. 39.58±4.28% respectively P<0.0001). Among angiographic data and procedural features, multivariable logistic regression analysis identified that advanced age, reperfusion time>6hours, SBP<100mmHg on admission, functional status of Killip class for heart failure≥3, lower EF (≤35%), low initial myocardial blush grade (≤1) before PCI, long target lesion length, larger reference diameter of vessel (>3.5mm) and high thrombus burden on angiography were found to be independent predictors of no-reflow (P<0.05).
Conclusion:
No-reflow phenomenon after PCI for STEMI is complex and multifactorial and can be identified by simple clinical, angiographic, and procedural features. Preprocedural characters of the lesion and early perfusion decides the fate of the outcome.
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