Abstract 12525: Persistent No Reflow Phenomenon After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Was Associated With a Poor In-Hospital Outcome and Increased Long-Term Mortality, Mainly Driven by Increased Cardiac Mortality
Introduction: There is limited information on the transient or persistent no reflow phenomena in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).
Hypothesis: We aimed to evaluate the long-term clinical outcomes of transient of persistent no reflow phenomenon following PCI in patients with AMI.
Methods: The study analyzed 4329 patients with AMI who underwent PCI using coronary stents in the COnvergent REgistry of cAtholic and chonnAm university for Acute MI (COREA-AMI) from 2004 to 2009 (2668 ST-elevation and 1661 non-ST-elevation MI patients): 4071 patients without any no reflow during PCI, 213 patients with transient no reflow (final thrombolysis in myocardial infarction [TIMI] flow grade 3 after adequate management of no reflow), and 45 patients with persistent no reflow (final TIMI flow grade ≤ 2 despite of management for no reflow). The primary endpoint was all-cause mortality during 3-year follow-up. We also analyzed the incidence of cardiac death, nonfatal myocardial infarction (MI), stroke, target vessel revascularization, and stent thrombosis.
Results: More all-cause (738 [18.1%] vs. 52 [24.4%] vs. 21 patients [46.7%], p <0.001), cardiac (321 [7.9%] vs. 28 [13.1%] vs. 18 patients [40.0%], p <0.001), and in-hospital deaths (72 [1.8%] vs. 11 [5.2%] vs. 7 patients [15.6%], p <0.001) occurred in the persistent no reflow group compared with the normal or transient no reflow groups. Persistent no reflow was associated with higher mortality (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.08-3.65, p = 0.028) and cardiac mortality (HR 3.28, 95% CI 1.54-6.95, p = 0.002) compared with the normal reflow group. Although the incidences of the secondary endpoints were comparable among groups, patients with persistent no reflow experienced more early stent thrombosis (HR 5.19, 95% CI 1.10-24.46, p = 0.037).
Conclusions: The persistent no reflow phenomenon is a rare complication of PCI using coronary stents in patients with AMI. It was associated with a poor in-hospital outcome and increased long-term mortality, mainly driven by increased cardiac mortality.
Author Disclosures: M. Kim: None. H. Jeong: None. K. Park: None. D. Sim: None. Y. Hong: None. J. Kim: None. M. Jeong: None. J. Cho: None. J. Park: None. Y. Ahn: None.
- © 2014 by American Heart Association, Inc.