Abstract 15199: Long-Term Prognostic Impact of No-Reflow Phenomenon After Primary Percutaneous Coronary Intervention in Patients With St-Segment Elevation Myocardial Infarction
Background: Previous studies have demonstrated a strong association between no-reflow phenomenon, infarct size and adverse cardiovascular outcome in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). However, few data exist on the impact of no-reflow on long-term mortality in patients with STEMI treated with primary PCI.
Methods: A total of 2300 STEMI patients undergoing primary PCI with the use of DES were consecutively enrolled in the multicenter AMI registry of Korea. No-reflow phenomenon was diagnosed using angiographic criteria. The primary outcome was all-cause mortality during follow-up. For validation of survival data, the vital status was obtained in 100% of patients from the Office of Statistics, Korea.
Results: The no-reflow phenomenon was diagnosed in 155 patients (6.7%). Independent predictors of no reflow were older age (p=0.001), reduced pre-PCI TIMI flow grade (p=0.022), high-sensitivity C-reactive protein (P=0.001), and higher maximal CK-MB level (p=0.002). During a median follow-up of 44 months (interquartile range, 36-53 months), patients with no-reflow phenomenon showed higher rate of mortality compared to those without (30.3% vs. 18.0%, p<0.001). The multivariate Cox proportional hazards model identified the no-reflow phenomenon as an independent correlate of long-term mortality (adjusted hazard ratio [HR]: 1.55; 95% confidence interval [CI]: 1.12 to 2.15; p=0.009). Time period-specific analyses demonstrated that the association between no reflow phenomenon and mortality was significant and stronger for short-term (<30-day) mortality (adjusted HR: 2.9, 95% CI: 1.51 to 5.55; p < 0.001) but was not significant for longer-term mortality (≥30-day) (adjusted HR: 1.25, 95% CI: 0.70 to 2.21; p = 0.46).
Conclusion: In patients with STEMI undergoing primary PCI, no-reflow phenomenon is an independent predictor of long-term mortality.
- © 2013 by American Heart Association, Inc.