Predictors and long-term prognostic implications of angiographic slow/no-flow during percutaneous coronary intervention for acute myocardial infarction.
OBJECTIVE
In patients with acute myocardial infarction (AMI), angiographic slow/no-flow during percutaneous coronary intervention (PCI) may lead to unfavorable outcomes. The aim of our study was to investigate the predictors and long-term prognosis of AMI patients with angiographic slow/no-flow.


METHODS
We evaluated 228 consecutive AMI patients with either normal flow (Thrombolysis in Myocardial Infarction [TIMI] flow grade 3)(n=192) or slow/no-flow (< or =TIMI-2)(n=36) based on cineangiograms performed during PCI.


RESULTS
Multivariable analysis demonstrated that a long lesion (> or =10 mm)(odds ratio [OR], 3.514; 95% confidence interval [CI], 1.505-8.206; p=0.004) and acute hyperglycemia (> or =180 mg/dl)(OR, 3.011; 95% CI, 1.211-7.485; p=0.018) were significant and independent predictors of angiographic slow/no-flow. Further, we found that there was a high correlation (89%) for predicting angiographic slow/no-flow when the optimal cut-off values of lesion length (10.45 mm) and blood glucose levels on admission (187.5 mg/dl) were combined as identified by analysis of the receiver operating characteristic curves. One-year mortality and incidence of major adverse cardiac and cerebrovascular events (MACCE) were significantly higher in the slow/no-flow group than that in the normal flow group. Angiographic slow/no-flow was independently predictive of MACCE (hazard ratio [HR], 3.642; 95% CI, 1.208-10.980; p=0.022) and cardiac death (HR, 5.287; 95% CI, 1.155-24.204; p=0.032).


CONCLUSIONS
Lesion length and blood glucose level on admission can be used to stratify AMI patients into a lower or higher risk for angiographic slow/no-flow before optimal coronary intervention. In addition, angiographic slow/no-flow predicts an adverse outcome in AMI patients.
Suenari
Kazuyoshi
K
Department of Medicine and Molecular Science, Graduate School of Biomedical Science, Hiroshima University, Hiroshima. suenari@bg7.so-net.ne.jp
Shiode
Nobuo
N
Shirota
Kinya
K
Ishii
Hiroshige
H
Goto
Kenji
K
Sairaku
Akinori
A
Mikami
Shinsuke
S
Nakano
Yukiko
Y
Chayama
Kazuaki
K
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity / Q000502:physiology*; D002932:Cineangiography; D017023:Coronary Angiography / Q000379:methods*; D003328:Coronary Thrombosis / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D015912:Thrombolytic Therapy