The no-reflow phenomenon in acute myocardial infarction after primary angioplasty: incidence, predictive factors, and long-term outcomes.
OBJECTIVE
We evaluated the incidence and predictive factors of impaired microcirculation, defined as myocardial blush grade (MBG) 0, in patients undergoing primary angioplasty for ST-elevation myocardial infarction.


METHODS
Since 2001, in our province a network has been operating for the treatment of ST-elevation myocardial infarction based on the use of primary angioplasty in all high-risk patients and, up to December 2005, 530 patients were treated. Core angiographic analysis was performed, and images were technically adequate to assess epicardial and myocardial perfusion rates in 530 patients. Outcomes were examined according to postprocedural myocardial blush.


RESULTS
Patients with MBG 0-1 had more diabetes and previous anterior myocardial infarction, longer delay to mechanical reperfusion, higher baseline mean leukocyte count, higher baseline C-reactive protein level as well as higher in-hospital mortality. The correlation between MBG, Thrombolysis in Myocardial Infarction (TIMI) flow grade and ST-segment resolution suggests that MBG is an optimal marker of reperfusion.


CONCLUSIONS
Our results indicate that a fair percentage of patients with TIMI 3 flow after primary angioplasty do not show signs of effective reperfusion (MBG 0) and have a higher in-hospital mortality rate. Myocardial reperfusion after primary angioplasty, as assessed by MBG, strongly correlates with other markers of reperfusion success, including ST-segment resolution.
Romano
Michele
M
Division of Cardiology, Carlo Poma Hospital, Mantova, Italy. m67romano@hotmail.com
Buffoli
Francesca
F
Tomasi
Luca
L
Aroldi
Marco
M
Lettieri
Corrado
C
Ferrari
Maria Rosa
MR
Zanini
Roberto
R
D002097:C-Reactive Protein / Q000378:metabolism; D017023:Coronary Angiography; D003326:Coronary Circulation; D023903:Coronary Restenosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D002097:C-Reactive Protein