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No reflow phenomenon in CAD patients after percutaneous coronary intervention: A prospective hospital based
Shivani Rao1, Rajeev Bhardwaj2, P C Negi3
1Department of Cardiology, ABVIMS and Dr RML Hospital, New Delhi, India.
Insights
No-reflow, a complication of percutaneous coronary intervention (PCI), affects 9.3% of patients. Identifying risk factors like hypertension and obesity is crucial for improving outcomes in patients with ST-elevation myocardial infarction (STEMI) and other coronary syndromes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- No-reflow phenomenon is a critical complication during percutaneous coronary intervention (PCI).
- Understanding its incidence and predictors is vital for managing patients with acute coronary syndromes (ACS) and stable angina.
Purpose of the Study:
- To assess the incidence, risk factors, and outcomes of no-reflow in patients undergoing PCI.
- To evaluate the association of no-reflow with specific clinical and angiographic characteristics.
- To compare outcomes between patients with and without no-reflow, and explore the role of myocardial perfusion grade (MPG).
Main Methods:
- Retrospective analysis of 449 patients undergoing PCI for STEMI, NSTEMI, unstable angina, and stable angina.
- Assessment of incidence, risk factors (hypertension, dyslipidemia, obesity, smoking), and angiographic findings (left main disease, multiple stents, lesion length, thrombus grade).
- Evaluation of in-hospital and short-term outcomes, including mortality, cardiogenic shock, heart failure, and Major Adverse Cardiovascular Events (MACE).
Main Results:
- No-reflow occurred in 9.3% of patients (42/449).
- Significant risk factors included hypertension, dyslipidemia, obesity, and smoking.
- No-reflow was associated with left main disease, multiple stents, longer target lesion length (≥20 mm), and higher thrombus grade.
- Patients with no-reflow experienced poorer in-hospital and short-term outcomes, including increased mortality, cardiogenic shock, heart failure, and MACE.
- Interestingly, 23.4% of patients with normal flow had poor MPG (0/1), with 10% mortality.
Conclusions:
- No-reflow is linked to adverse outcomes following PCI, emphasizing the need for meticulous risk factor management.
- Identifying and mitigating risk factors can improve patient outcomes.
- Myocardial perfusion grade (MPG) may serve as a valuable predictor of outcomes in PCI patients.
Abstract:
The present study assessed incidence, risk factors, in-hospital and short-term outcomes associated with no-reflow in patients undergoing percutaneous coronary intervention (PCI) in STEMI, NSTEMI, unstable angina and stable angina. Out of 449 patients, 42 (9.3%) developed no-reflow. Hypertension, dyslipidemia, obesity and smoking were significant risk factors. There was significant association of no-reflow with left main disease, multiple stents, target lesion length≥ 20 mm and higher thrombus grade. Interestingly, 93 patients (23.4%) of normal flow had myocardial perfusion grade (MPG) of 0/1 with mortality in 9 (10%) patients. No-reflow is associated with poor in-hospital and short-term outcomes with higher incidence of death, cardiogenic shock, heart failure and MACE. Knowledge of risk factors of no-reflow portends a more meticulous approach to improve final outcomes. MPG could be better predictor of outcomes in these patients.
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