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2018, vol. 75, iss. 10, pp. 1009-1013
Factors influencing no-reflow phenomenon in patients with ST-segment myocardial infarction treated with primary percutaneous coronary intervention
aMilitary Medical Academy, Clinic for Emergency Internal Medicine, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade
bMilitary Medical Academy, Clinic for Emergency Internal Medicine, Belgrade
cMilitary Medical Academy, Clinic of Cardiology, Belgrade
dClinical Center of Serbia, Belgrade

emaildrnemanjadjenic@gmail.com
Abstract
Background/Aim. It is not know which factors influence no-reflow phenomenon after successful primary percutaneous intervention (pPCI) in patients with myocardial infarction with ST elevation (STEMI). The aim of this study was to estimate predictive value of some admission characteristics of patients with STEMI, who underwent pPCI, for the development of no-reflow phenomenon. Worse clinical outcome in patients with no-reflow points to importance of selection and aggressive treatment in a group at high risk. Methods. This was retrospective and partly prospective study which included 491 consecutive patients with STEMI, admitted to a single centre, during the period from 2000 to September 2015, who underwent pPCI. Descriptive characteristics of the patients, presence of classical risk factors for cardiovascular disease, total ischemic time and clinical features at admission were all estimated as predictors for the development of no-reflow phenomenon. No-reflow phenomenon is defined as the presence of thrombolysis in myocardial infarction (TIMI) < 3 coronary flow at the end of the pPCI procedure, or ST-segment resolution by less than 50% in the first hours after the procedure. The significance of the predictive value of some parameters was evaluated by univariate and multivariate regression analysis. In univariate analysis, we used the x2 test and Mann Whitney and Student's t-tests. Results. No-reflow phenomenon was detected in 84 (17.1%) patients (criteria used: TIMI < 3 coronary flow) and in 144 (29.3%) patients (criteria used: ST-sement resolution < 50%). Patients older than 75 years [odds ratio (OR) = 2.53; 95% confidence interval (CI) 1.48-4.33; p = 0.001] and those who had Killip class at admission higher than 1 had increased risk to achieve TIMI-3 flow after pPCI. Killip class higher than 1 (OR 1.59; 95% CI 1.23-2.04; p < 0.001), left anterior descendent artery (LAD) as infarct related artery (IRA) and total ischemic time higher than 4 hour were associated with increased risk to failure of rapid ST segment resolution after pPCI. Conclusion. Older age and Killip class were main predictors of TIMI < 3 flow, and Killip class, LAD as IRA and longer total ischemic time were predictors for the failure of rapid ST segment resolution after pPCI.
References
Eeckhout, E., Kern, M.J. (2001) The coronary no-reflow phenomenon: A review of mechanisms and therapies. Eur Heart J, 22(9): 729-39
Harrison, R.W., Aggarwal, A., Ou, F., Klein, L.W., Rumsfeld, J.S., Roe, M.T., Wang, T.Y. (2013) Incidence and Outcomes of No-Reflow Phenomenon During Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction. American Journal of Cardiology, 111(2): 178-184
Iwakura, K., Ito, H., Kawano, S., Shintani, Y., Yamamoto, K., Kato, A., Ikushima, M., Tanaka, K., Kitakaze, M., Hori, M., Higashino, Y., Fujii, K. (2001) Predictive factors for development of the no-reflow phenomenon in patients with reperfused anterior wall acute myocardial infarction. Journal of the American College of Cardiology, 38(2): 472-477
Kirma, C., Izgi, A., Dundar, C., Tanalp, A.C., Oduncu, V., Aung, S.M., Sonmez, K., Mutlu, B., Ozdemir, N., Erentug, V. (2008) Clinical and Procedural Predictors of No-Reflow Phenomenon After Primary Percutaneous Coronary Interventions. Circulation Journal, 72(5): 716-721
Mazhar, J., Mashicharan, M., Farshid, A. (2016) Predictors and outcome of no-reflow post primary percutaneous coronary intervention for ST elevation myocardial infarction. IJC Heart & Vasculature, 10: 8-12
Steg, P.G., James, S.K., Atar, D., Badano, L.P., Blömstrom-Lundqvist, C., Borger, M.A., i dr. (2012) Task Force on the management of STsegment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J, 33(20); 2569-619
Vrints, C. (2009) Pathophysiology of the no-reflow phenomenon. Acute Cardiac Care, 11(2): 69-76
 

About

article language: English
document type: Original Scientific Paper
DOI: 10.2298/VSP160405030D
published in SCIndeks: 25/10/2018
peer review method: double-blind
Creative Commons License 4.0

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