Abstract 3435: Clinical and Angiographic Risk Factors for Mechanical Obstruction and No Reflow Following Percutaneous Coronary Intervention
Introduction: Poor epicardial blood flow following percutaneous coronary intervention (PCI) independently predicts adverse clinical outcomes, but there are limited data on the clinical predictors of this phenomenon, particularly with respect to subtypes such as No Reflow. To better delineate these phenomena, we evaluated the demographic and angiographic risk factors for poor post-PCI epicardial flow in a large, single center registry.
Methods: All PCI cases at Wake Forest University between January 1998 and April 2006 were included in the analysis (n=12,894 cases). Poor post-PCI epicardial flow was defined as a TIMI flow grade of <3. Cases of poor post-PCI epicardial flow were divided into those with an evident Mechanical Obstruction (MO) and those without a visible obstruction, termed No Reflow (NR). Multivariable logistic regression was used to identify characteristics that independently predicted MO and NR.
Results: During the study period, there were 12,894 PCI cases representing 20,634 treated lesions. MO occurred in 401 (1.9%) of the lesions and NR occurred in 240 (1.2%) of the lesions. Independent predictors of MO and NR are listed in the Figure⇓.
Conclusions: Clinical and angiographic risk factors reflecting disease severity and acuity predicted both MO and NR. However, some differences between MO and NR were present. In particular, the novel finding of an inverse association between chronic lung disease and NR suggests that host physiology may modify the risk of No Reflow. Further study of these factors may better define the subtypes of poor post-PCI epicardial flow and enhance our ability to predict and prevent adverse outcomes related to poor post-PCI epicardial flow.