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Long-Term Prognostic Value of Angiographic No-Reflow Phenomenon in Patients With Non-ST-Segment Elevation Myocardial
Weijie Shi1, Zhipeng Liu1, Yonghuai Wang2
1Department of Cardiology, The First Hospital of China Medical University, Shenyang, China.
Insights
The angiographic no-reflow phenomenon strongly predicts long-term mortality in non-ST-elevation myocardial infarction (NSTEMI) patients. Adding no-reflow to the GRACE score significantly improves long-term outcome prediction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The Global Registry of Acute Coronary Events (GRACE) score predicts short-term outcomes in non-ST-elevation myocardial infarction (NSTEMI) but has moderate long-term predictive ability.
- The prognostic value of angiographic no-reflow for long-term outcomes in NSTEMI and its incremental benefit over the GRACE score are not well-established.
Purpose of the Study:
- To evaluate the prognostic significance of angiographic no-reflow for long-term mortality in NSTEMI patients.
- To assess the additive prognostic value of angiographic no-reflow to the GRACE risk score.
Main Methods:
- Retrospective single-center cohort study of consecutive NSTEMI patients.
- Assessment of angiographic no-reflow post-percutaneous coronary intervention (PCI).
- Primary endpoint: 3-year all-cause mortality, analyzed using multivariate Cox regression and propensity score matching (PSM).
Main Results:
- No-reflow occurred in 33.3% of 1271 NSTEMI patients.
- Angiographic no-reflow was independently associated with increased risks of 3-year all-cause and cardiac mortality (HRs ranging from 2.52 to 4.38 before PSM, and 2.79 to 3.03 after PSM).
- Incorporating no-reflow into the GRACE score significantly improved discrimination and reclassification for mortality (Delta AUC > 0.098, NRI > 0.220).
Conclusions:
- Angiographic no-reflow is a strong independent predictor of long-term mortality in NSTEMI patients.
- The presence of angiographic no-reflow provides significant incremental prognostic value beyond the GRACE score for predicting long-term outcomes.
Background:
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.
Hypothesis:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
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