Korean Circ J.  2016 Jul;46(4):490-498. 10.4070/kcj.2016.46.4.490.

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

• Kim MC
• Cho JY
• Jeong HC
• Lee KH
• Park KH
• Sim DS
• Yoon NS
• Youn HJ
• Kim KH
• Hong YJ
• Park HW
• Kim JH
• Jeong MH
• Cho JG
• Park JC
• Seung KB
• Chang K
• Ahn Y

• KMID: 2344423
• DOI: http://doi.org/10.4070/kcj.2016.46.4.490

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≤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.

Keyword

Myocardial infarction; No-reflow phenomenon; Percutaneous coronary interventions

MeSH Terms

Follow-Up Studies
Heart Failure
Humans
Incidence
Mortality
Myocardial Infarction*
No-Reflow Phenomenon
Percutaneous Coronary Intervention*
Stents
Thrombosis

Figure

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  Fig. 1 In-hospital outcomes among normal reflow, transient no reflow, and persistent no reflow groups. Data are presented as a percentage. *p≤0.05, comparison between transient and persistent no reflow groups. VT: ventricular tachycardia, VF: ventricular fibrillation.

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  Fig. 2 3-year all-cause mortality between patients with transient and persistent no reflow. AMI: acute myocardial infarction.

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  Fig. 3 Clinical outcomes among normal reflow, transient no reflow, and persistent no reflow groups during follow-up period. *p≤0.05, comparison between transient and persistent no reflow group. Data are presented as percentages. CHF: congestive heart failure, MI: myocardial infarction.

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