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Long-Term Clinical Outcomes of Transient and Persistent No Reflow Phenomena following Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

  • Kim, Min Chul (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Cho, Jae Yeong (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Jeong, Hae Chang (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Lee, Ki Hong (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Park, Keun Ho (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Sim, Doo Sun (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Yoon, Nam Sik (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Youn, Hyun Joo (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Kim, Kye Hun (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Hong, Young Joon (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Park, Hyung Wook (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Kim, Ju Han (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Jeong, Myung Ho (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Cho, Jeong Gwan (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Park, Jong Chun (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Seung, Ki-Bae (Department of Cardiology, Seoul St Mary's Hospital, The Catholic University School of Medicine) ;
  • Chang, Kiyuk (Department of Cardiology, Seoul St Mary's Hospital, The Catholic University School of Medicine) ;
  • Ahn, Youngkeun (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine)
  • Received : 2015.09.05
  • Accepted : 2015.12.08
  • Published : 2016.07.30

Abstract

Background and Objectives: There is limited information on the transient or persistent no reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Subjects and Methods: The study analyzed 4329 patients with AMI from a Korean multicenter registry who underwent PCI using coronary stents (2668 ST-elevation and 1661 non-ST-elevation myocardial infarction [MI] patients): 4071 patients without any no reflow, 213 with transient no reflow (no reflow with final thrombolysis in myocardial infarction [TIMI] flow grade 3), and 45 with persistent no reflow (no reflow with final TIMI flow grade${\leq}2$). The primary endpoint was all-cause mortality during 3-year follow-up. We also analyzed the incidence of cardiac mortality, non-fatal MI, re-hospitalization due to heart failure, target vessel revascularization, and stent thrombosis. Results: The persistent no reflow group was associated with higher all-cause 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. Transient no reflow increased all-cause mortality only when compared with normal reflow group (HR 1.58, 95% CI 1.11-2.24, p=0.010). When comparing transient and persistent no reflow, persistent no reflow was associated with increased all-cause mortality (46.7 vs. 24.4%, log rank p=0.033). Conclusion: The persistent no reflow phenomenon was associated with a poor in-hospital outcome and increased long-term mortality mainly driven by increased cardiac mortality compared to the transient no reflow phenomenon or normal reflow.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea, Ministry for Health & Welfare

References

  1. Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention. Circulation 2008;117:3152-6. https://doi.org/10.1161/CIRCULATIONAHA.107.742312
  2. Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. J Am Coll Cardiol 2009;54:281-92. https://doi.org/10.1016/j.jacc.2009.03.054
  3. Morishima I, Sone T, Okumura K, et al. Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol 2000;36:1202-9. https://doi.org/10.1016/S0735-1097(00)00865-2
  4. Ndrepepa G, Tiroch K, Keta D, et al. Predictive factors and impact of no reflow after primary percutaneous coronary intervention in patients with acute myocardial infarction. Circ Cardiovasc Interv 2010;3:27-33. https://doi.org/10.1161/CIRCINTERVENTIONS.109.896225
  5. Ndrepepa G, Tiroch K, Fusaro M, et al. 5-year prognostic value of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction. J Am Coll Cardiol 2010;55:2383-9. https://doi.org/10.1016/j.jacc.2009.12.054
  6. Brosh D, Assali AR, Mager A, et al. Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. Am J Cardiol 2007;99:442-5. https://doi.org/10.1016/j.amjcard.2006.08.054
  7. Harrison RW, Aggarwal A, Ou FS, et al. Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction. Am J Cardiol 2013;111:178-84. https://doi.org/10.1016/j.amjcard.2012.09.015
  8. Mehta RH, Harjai KJ, Boura J, et al. Prognostic significance of transient no-reflow during primary percutaneous coronary intervention for ST-elevation acute myocardial infarction. Am J Cardiol 2003;92:1445-7. https://doi.org/10.1016/j.amjcard.2003.08.056
  9. Lee CH, Wong HB, Tan HC, et al. Impact of reversibility of no reflow phenomenon on 30-day mortality following percutaneous revascularization for acute myocardial infarction-insights from a 1,328 patient registry. J Interv Cardiol 2005;18:261-6. https://doi.org/10.1111/j.1540-8183.2005.00041.x
  10. Chan W, Stub D, Clark DJ, et al. Usefulness of transient and persistent no reflow to predict adverse clinical outcomes following percutaneous coronary intervention. Am J Cardiol 2012;109:478-85. https://doi.org/10.1016/j.amjcard.2011.09.037
  11. Jinnouchi H, Sakakura K, Wada H, et al. Transient no reflow following primary percutaneous coronary intervention. Heart Vessels 2014;29:429-36. https://doi.org/10.1007/s00380-013-0379-1
  12. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1-266. https://doi.org/10.1016/S0272-6386(02)70081-4
  13. The TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial: phase 1 findings. N Engl J Med 1985;312:932-6.
  14. Khattab AA, Hamm CW, Senges J, et al. Prognostic value of the modified American College of Cardiology/American Heart Association lesion morphology classification for clinical outcome after sirolimus-eluting stent placement (results of the prospective multicenter German Cypher Registry). Am J Cardiol 2008;101:477-82. https://doi.org/10.1016/j.amjcard.2007.09.094
  15. Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007;115:2344-51. https://doi.org/10.1161/CIRCULATIONAHA.106.685313
  16. Abbo KM, Dooris M, Glazier S, et al. Features and outcome of no-reflow after percutaneous coronary intervention. Am J Cardiol 1995;75:778-82. https://doi.org/10.1016/S0002-9149(99)80410-X
  17. Al Suwaidi J, Holmes DR Jr, Salam AM, Lennon R, Berger PB. Impact of coronary artery stents on mortality and nonfatal myocardial infarction: meta-analysis of randomized trials comparing a strategy of routine stenting with that of balloon angioplasty. Am Heart J 2004;147:815-22. https://doi.org/10.1016/j.ahj.2003.11.025
  18. Claessen BE, Smits PC, Kereiakes DJ, et al. Impact of lesion length and vessel size on clinical outcomes after percutaneous coronary intervention with everolimus-versus paclitaxel-eluting stents: pooled analysis from the SPIRIT (clinical evaluation of the XIENCE V everolimus eluting coronary stent system) and COMPARE (second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice) randomized trials. JACC Cardiovasc Interv 2011;4:1209-15. https://doi.org/10.1016/j.jcin.2011.07.016
  19. Hildick-Smith D, de Belder AJ, Cooter N, et al. Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies. Circulation 2010;121:1235-43. https://doi.org/10.1161/CIRCULATIONAHA.109.888297
  20. Brodie B, Pokharel Y, Garg A, et al. Predictors of early, late, and very late stent thrombosis after primary percutaneous coronary intervention with bare-metal and drug-eluting stents for ST-segment elevation myocardial infarction. JACC Cardiovasc Interv 2012;5:1043-51. https://doi.org/10.1016/j.jcin.2012.06.013
  21. Hong SN, Ahn Y, Hwang SH, et al. Usefulness of preprocedural N-terminal pro-brain natriuretic peptide in predicting angiographic no-reflow phenomenon during stent implantation in patients with ST-segment elevation acute myocardial infarction. Am J Cardiol 2007;100:631-4. https://doi.org/10.1016/j.amjcard.2007.03.075
  22. Jeong YH, Kim WJ, Park DW, et al. Serum B-type natriuretic peptide on admission can predict the 'no-reflow' phenomenon after primary drug-eluting stent implantation for ST-segment elevation myocardial infarction. Int J Cardiol 2010;141:175-81. https://doi.org/10.1016/j.ijcard.2008.11.189
  23. Magro M, Nauta ST, Simsek C, et al. Usefulness of the SYNTAX score to predict "no reflow" in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Am J Cardiol 2012;109:601-6. https://doi.org/10.1016/j.amjcard.2011.10.013
  24. Wu X, Mintz GS, Xu K, et al. The relationship between attenuated plaque identified by intravascular ultrasound and no-reflow after stenting in acute myocardial infarction: the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial. JACC Cardiovasc Interv 2011;4:495-502.
  25. Hong YJ, Jeong MH, Choi YH, et al. Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis. Eur Heart J 2011;32:2059-66. https://doi.org/10.1093/eurheartj/ehp034
  26. Iijima R, Shinji H, Ikeda N, et al. Comparison of coronary arterial finding by intravascular ultrasound in patients with "transient no-reflow" versus "reflow" during percutaneous coronary intervention in acute coronary syndrome. Am J Cardiol 2006;97:29-33. https://doi.org/10.1016/j.amjcard.2005.07.104
  27. Alhadramy O, Westerhout CM, Brener SJ, Granger CB, Armstrong PW; APEX AMI Investigators. Is visual interpretation of coronary epicardial flow reliable in patients with ST-elevation myocardial infarction undergoing primary angioplasty? Insights from the angiographic substudy of the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Am Heart J 2010;159:899-904. https://doi.org/10.1016/j.ahj.2010.02.028
  28. Brener SJ, Moliterno DJ, Aylward PE, et al. Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI angiographic study. Eur Heart J 2008;29:1127-35. https://doi.org/10.1093/eurheartj/ehn125
  29. Brener SJ, Cristea E, Lansky AJ, Fahy M, Mehran R, Stone GW. Operator versus core laboratory assessment of angiographic reperfusion markers in patients undergoing primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction. Circ Cardiovasc Interv 2012;5:563-9. https://doi.org/10.1161/CIRCINTERVENTIONS.112.969022

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