Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction

Robert W. Harrison, Atul Aggarwal, Fang-Shu Ou, Lloyd W. Klein, John S. Rumsfeld, Matthew T. Roe, Tracy Y. Wang

Research output: Contribution to journalArticle

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Abstract

Previous studies describing the no-reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were largely confined to single-center studies or small registries. To better characterize the incidence, predictors, and outcomes of the no-reflow phenomenon in a large contemporary population, we analyzed patients with AMI who were undergoing PCI of native coronary artery stenoses in the CathPCI Registry from January 1, 2004 through September 5, 2008 (n = 291,380). The angiographic no-reflow phenomenon was site reported using a standardized definition. No-reflow developed in 2.3% of the patients with AMI (n = 6,553) during PCI. Older age, ST-segment elevation AMI, prolonged interval from symptom onset to admission, and cardiogenic shock were clinical variables independently associated with the development of no-reflow (p <0.001). The angiographic factors independently associated with no-reflow included longer lesion length, higher risk class C lesions, bifurcation lesions, and impaired preprocedure Thrombolysis In Myocardial Infarction flow (p <0.001). No-reflow was associated with greater in-hospital mortality (12.6% vs 3.8%, adjusted odds ratio 2.20, 95% confidence interval 1.97 to 2.47, p <0.001) and unsuccessful lesion outcome (29.7% vs 6.6%, adjusted odds ratio 4.70, 95% confidence interval 4.28 to 5.17, p <0.001) compared to patients without no-reflow. In conclusion, the development of no-reflow, although relatively uncommon during PCI for AMI, is associated with adverse clinical outcomes. Upfront strategies to reduce the incidence of no-reflow could be considered for high-risk patients to improve outcomes.

Original languageEnglish (US)
Pages (from-to)178-184
Number of pages7
JournalAmerican Journal of Cardiology
Volume111
Issue number2
DOIs
StatePublished - Jan 15 2013
Externally publishedYes

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No-Reflow Phenomenon
Percutaneous Coronary Intervention
Myocardial Infarction
Incidence
Registries
Odds Ratio
Confidence Intervals
Cardiogenic Shock
Coronary Stenosis
Hospital Mortality
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction. / Harrison, Robert W.; Aggarwal, Atul; Ou, Fang-Shu; Klein, Lloyd W.; Rumsfeld, John S.; Roe, Matthew T.; Wang, Tracy Y.

In: American Journal of Cardiology, Vol. 111, No. 2, 15.01.2013, p. 178-184.

Research output: Contribution to journalArticle

Harrison, Robert W. ; Aggarwal, Atul ; Ou, Fang-Shu ; Klein, Lloyd W. ; Rumsfeld, John S. ; Roe, Matthew T. ; Wang, Tracy Y. / Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction. In: American Journal of Cardiology. 2013 ; Vol. 111, No. 2. pp. 178-184.
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abstract = "Previous studies describing the no-reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were largely confined to single-center studies or small registries. To better characterize the incidence, predictors, and outcomes of the no-reflow phenomenon in a large contemporary population, we analyzed patients with AMI who were undergoing PCI of native coronary artery stenoses in the CathPCI Registry from January 1, 2004 through September 5, 2008 (n = 291,380). The angiographic no-reflow phenomenon was site reported using a standardized definition. No-reflow developed in 2.3{\%} of the patients with AMI (n = 6,553) during PCI. Older age, ST-segment elevation AMI, prolonged interval from symptom onset to admission, and cardiogenic shock were clinical variables independently associated with the development of no-reflow (p <0.001). The angiographic factors independently associated with no-reflow included longer lesion length, higher risk class C lesions, bifurcation lesions, and impaired preprocedure Thrombolysis In Myocardial Infarction flow (p <0.001). No-reflow was associated with greater in-hospital mortality (12.6{\%} vs 3.8{\%}, adjusted odds ratio 2.20, 95{\%} confidence interval 1.97 to 2.47, p <0.001) and unsuccessful lesion outcome (29.7{\%} vs 6.6{\%}, adjusted odds ratio 4.70, 95{\%} confidence interval 4.28 to 5.17, p <0.001) compared to patients without no-reflow. In conclusion, the development of no-reflow, although relatively uncommon during PCI for AMI, is associated with adverse clinical outcomes. Upfront strategies to reduce the incidence of no-reflow could be considered for high-risk patients to improve outcomes.",
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