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Korean Circ J. 2016 Jul;46(4):490-498. English. Multicenter Study. https://doi.org/10.4070/kcj.2016.46.4.490
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 .
Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea. cecilyk@hanmail.net
Department of Cardiology, Seoul St Mary's Hospital, The Catholic University School of Medicine, Seoul, Korea.
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 gradeā‰¤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.

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