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No-reflow rare, serious adverse event after revascularization
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No-reflow is rare but associated with adverse clinical outcomes during PCI for acute MI, according to recent study results published in the American Journal of Cardiology.
“Given the association between the development of no-reflow and an unsuccessful lesion outcome in our study, no-reflow might be a mediator of the greater mortality in this population,” researchers wrote.
In the study, researchers from four US sites analyzed 291,380 patients from 886 sites with acute MI who were undergoing PCI of coronary artery stenoses using the CathPCI Registry from January 2004 to September 2008.
No-reflow occurred in 2.3% of patients (n=6,553) with acute MI during PCI. Clinical variables independently associated with the development of no-reflow included older age per 10-year increase (OR=1.14; 95% CI, 1.12-1.17), STEMI (OR=1.39; 95% CI, 1.30-1.48), interval from symptom onset to admission of more than 12 hours (OR=1.18; 95% CI, 1.10-1.26) and cardiogenic shock at presentation (OR=1.83; 95% CI, 1.69-1.98).
Angiographic factors independently associated with no-reflow included longer lesion length per 10-mm increase (OR=1.17; 95% CI, 1.14-1.20), American College of Cardiology/American Heart Association Class C lesion (OR=1.47; 95% CI, 1.36-1.59), bifurcation lesions (OR=1.29; 95% CI, 1.19-1.40) and impaired preprocedure TIMI flow (0 vs. 3, OR=2.12; 95% CI, 1.83-2.45; and 1 or 2 vs. 3, OR=1.84; 95% CI, 1.60-2.12).
Compared with patients who did not develop no-reflow, those who did had a greater risk for in-hospital mortality (12.6% vs. 3.8%; adjusted OR=2.2; 95% CI, 1.97-2.47) and unsuccessful lesion outcome (29.7% vs. 6.6%; adjusted OR=4.7; 95% CI, 4.28-5.17).
Disclosure: The researchers report no relevant financial disclosures.
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