title: Predictors and long-term prognosis of angiographic slow/no-reflow phenomenon during emergency percutaneous coronary intervention for ST-elevated acute myocardial infarction.
abstract: OBJECTIVE
  Angiographic slow/no-reflow during emergency percutaneous coronary intervention (PCI) in patients with ST-elevated acute myocardial infarction (AMI) may result in unfavorable outcomes. The aim of our study was to investigate the clinical factors and angiographic findings that predict slow/no-reflow phenomenon and the long-term prognosis of AMI patients with angiographic slow/no-reflow.
  
  
  METHODS
  A total of 210 consecutive AMI patients, who underwent primary PCI within 12 hours of symptom onset were divided into a normal flow group (thrombolysis in myocardial infarction [TIMI] flow grade 3, n = 169) and a slow/no-reflow group (≤TIMI flow grade 2, n = 41), based on cineangiograms performed during PCI.
  
  
  RESULTS
  A total of 41 patients (19.5%) developed slow/no-reflow phenomenon. Univariate analysis showed that delayed reperfusion, high thrombus burden on baseline angiography, and acute hyperglycemia all correlated with slow/no-reflow (P < 0.05 for all). Multivariate analysis revealed that hyperglycemia on admission (≥10 mmol/L; odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.423-2.971, P = 0.012), reperfusion time (≥6 h; OR:1.4, 95% CI: 1.193-1.695, P = 0.040), and high thrombus burden (OR: 1.6, 95% CI: 1.026-2.825, P = 0.031) were significant and independent predictors of angiographic slow/no-reflow. The 6-month mortality and incidence of major adverse cardiac and cerebrovascular events (MACCE) were significantly higher in the slow/no-reflow group than in the normal flow group. Angiographic slow/no-reflow was independently predictive of MACCE (hazard ratio [HR]: 2.642, 95% CI: 1.304-5.932, P = 0.028).
  
  
  CONCLUSIONS
  Delayed reperfusion, high thrombus burden on baseline angiography, and blood glucose level on admission can be used to stratify AMI patients into a lower or higher risk for angiographic slow/no-reflow during PCI. In addition, angiographic slow/no-reflow predicts an adverse outcome in AMI patients.
authors.affiliation: Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Dong-bao
authors.forename: Hua
authors.initials: H
authors.lastname: Qi
authors.forename: Liu
authors.initials: L
authors.lastname: Zhi
authors.forename: Wang
authors.initials: W
authors.lastname: Shan
authors.forename: Jin
authors.initials: J
authors.lastname: Wei-ying
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000209:etiology; D016009:Chi-Square Distribution; D002681:China; D017023:Coronary Angiography; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000150:complications; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome