Abstract 4691: Incidence, Predictors and In-hospital Outcomes of No Reflow Phenomenon During Percutaneous Coronary Intervention for Acute Myocardial Infarction
Background: The clinical profile of patients who develop no reflow after contemporaneous percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is not well characterized.
Methods: AMI patients undergoing PCI of stenoses in native coronary arteries in National Cardiovascular Data Registry from 01/2004 – 09/2008 were analyzed (n=291,380). Angiographic no reflow (patients with transient cessation of flow during PCI) was site reported with no blinded core laboratory confirmation. Multivariable logistic modeling with generalized estimating equations was used to delineate factors independently associated with development of no reflow, incorporating medical history and angiographic variables. Similarly, adjusted odds ratios (OR) for adverse in-hospital outcomes associated with no reflow were calculated.
Results: No reflow developed in 2.3% of AMI patients (n=6,553) during PCI. Patients with no reflow had greater use of intra-aortic balloon pump (22.8 vs. 8.1%, p<0.0001) and post-procedure TIMI 0/1 flow (14.7 vs. 2.6%, p<0.0001) than patients without this complication. Clinical and angiographic variables significantly associated with no reflow are shown below (Table⇓). No reflow was associated with higher risks of in-hospital mortality (12.6% vs. 3.8% [p<0.001], adjusted OR 2.2, 95% CI 1.97–2.47,) and unsuccessful lesion outcome (>25% residual stenosis or incomplete TIMI flow, 29.7% vs. 6.4% [p<0.001], adjusted OR 4.7, 95% CI 4.28 –5.17).
Conclusion: No reflow is relatively uncommon during PCI for AMI, but is associated with adverse outcomes. Medications and devices that target no reflow phenomenon might be considered for upfront pre-procedure use among patients with greater risk of developing no reflow.