Long-Term Prognostic Value of Angiographic No-Reflow Phenomenon in Patients With Non-ST-Segment Elevation Myocardial...

The Global Registry of Acute Coronary Events (GRACE) score has proven value in predicting short-term prognosis in non-ST-elevation myocardial infarction (NSTEMI), but it has only moderate discrimination for long-term prognosis. The predictive value of the angiographic no-reflow phenomenon for long-term outcomes in NSTEMI patients and its incremental contribution to the GRACE score remain unclear.

This study aimed to determine: (1) the prognostic value of the angiographic no-reflow for long-term mortality in NSTEMI and (2) its additive value over the GRACE risk score.

This single-center cohort study retrospectively recruited consecutive patients with NSTEMI to further determine whether no-reflow occurred after PCI and conducted follow-up assessments. The primary endpoint was 3-year All-cause mortality.

A total of 1271 patients were included. No-reflow occurred in 423 patients (33.3%) and was absent in 848 (66.7%). Deaths were recorded in 114 patients (9.1%). Multivariate Cox regression and three propensity score methods were used to adjust for traditional cardiovascular risk factors. Before PSM, angiographic no-reflow was associated with increased risks of all-cause mortality (Hazards Ratio [HR]: 2.52; 95% CI: 1.70-3.74; p < 0.01) and cardiac death (HR: 4.38; 95% CI: 2.92-11.82; p = 0.019). After PSM, similar associations were observed for all-cause mortality (HR: 2.79; 95% CI: 1.73-7.50; p < 0.001) and cardiac death (HR: 3.03; 95% CI: 1.55-5.95; p = 0.008). When no-reflow was added to the GRACE score, it conferred significant discrimination and reclassification value for all-cause mortality (Delta AUC: 0.105; 95% CI: 0.050-0.169; p = 0.005; and net reclassification improvement [NRI] = 0.220) and cardiac death (Delta AUC: 0.098; 95% CI: 0.035-0.163; p = 0.007 and NRI = 0.292).

The angiographic no-reflow phenomenon strongly predicts long-term prognosis after NSTEMI; additionally, the angiographic no-reflow phenomenon has demonstrated significant discriminatory and reclassification power in the GRACE score.