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Comparison of the Outcomes between Coronary No-Reflow and Slow-Flow Phenomenon in Non-STEMI Patients
1Yeni Yuzyil University, Faculty of Medicine, Department of Cardiology, Istambul - Turquia.
Insights
Patients with coronary no-reflow phenomenon (CNP) after percutaneous coronary intervention for non-ST elevation myocardial infarction face higher risks of stroke and major adverse cardiovascular events. Coronary slow-flow phenomenon (CSFP) patients demonstrated better one-year outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Coronary slow-flow phenomenon (CSFP) and coronary no-reflow phenomenon (CNP) are linked to increased major cardiovascular adverse events (MACE).
- Understanding the comparative outcomes of CSFP and CNP in non-ST elevation myocardial infarction (NSTEMI) post-percutaneous coronary intervention (PCI) is crucial for risk stratification.
Purpose of the Study:
- To compare the one-year clinical follow-up outcomes between patients with CNP and CSFP who underwent PCI for NSTEMI.
- To identify predictors of CNP in the NSTEMI population.
Main Methods:
- A total of 858 NSTEMI patients undergoing PCI within 24 hours of symptom onset were analyzed.
- Patients were categorized into CSFP (n=221) and CNP (n=25) groups based on infarct-related artery TIMI flow.
- One-year clinical follow-up was conducted, with statistical significance set at p<0.05.
Main Results:
- CNP occurred in 2.91% and CSFP in 25.75% of patients.
- The CNP group exhibited significantly higher rates of stroke (24% vs. 2.70%) and MACE (44% vs. 23.10%) compared to the CSFP group.
- Body mass index (BMI) and baseline heart rate (HR) were identified as independent predictors of CNP.
Conclusions:
- Coronary no-reflow phenomenon (CNP) is associated with significantly worse clinical outcomes, including a higher risk of stroke, compared to coronary slow-flow phenomenon (CSFP) in NSTEMI patients post-PCI.
- Independent predictors for CNP include higher BMI and lower baseline heart rate.
Background:
Coronary slow-flow phenomenon (CSFP) and coronary no-reflow phenomenon (CNP) are associated with increased risk of major cardiovascular adverse events (MACE).
Objectives:
This study aimed to evaluate and compare the one-year clinical follow-up outcomes among patients with CNP and CSFP who underwent percutaneous coronary interventions (PCI) in non-ST elevation myocardial infarction (NSTEMI).
Methods:
This study included a total of 858 patients who were diagnosed with NSTEMI and underwent PCI within 24 h of symptom onset. The patients were divided into two groups, the CSFP group (n=221) and the CNP group (n=25), regarding the angiographic characteristics of thrombolysis in myocardial infarction (TIMI) flow of the infarct-related artery. Patients were followed for one-year. A p-value of <0.05 was considered significant.
Results:
CNP was observed in 2.91%, and CSFP was observed in 25.75% of the patients. Clinical endpoints analyzed that stroke was significantly higher in the CNP group than in the CSFP group (6 (24%) vs. 6 (2.70%), p<0.001) and MACE was significantly higher in the CNP group than in the CSFP group (11 (44%) vs. 51 (23.10%), p=0.022). Forward conditional logistic regression analysis demonstrated that body mass index (BMI) (OR=1.11, 95%CI: 1.00-1.24, p=0.038) and baseline heart rate (HR) (OR=0.923, 95%CI: 0.88-0.96, p<0.001) were the independent predictors of CNP in NSTEMI.
Conclusion:
CNP patients have worse clinical outcomes and a higher risk of stroke compared with CSFP patients in NSTEMI. (Arq Bras Cardiol. 2021; 116(5):856-864).
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