title: Usefulness of transient and persistent no reflow to predict adverse clinical outcomes following percutaneous coronary intervention.
abstract: The no reflow phenomenon is reported to occur in >2% of all percutaneous coronary interventions (PCIs) and portends a poor prognosis. We analyzed data from 5,286 consecutive patients who underwent PCI from the Melbourne Interventional Group (MIG) registry from April 2004 through January 2008 who had 30-day follow-up completed. Patients without no reflow (normal reflow, n = 5,031) were compared to 255 (4.8%) with no reflow (n = 217 for transient no reflow, n = 38 for persistent no reflow). Patients with transient or persistent no reflow were more likely to present with ST-elevation myocardial infarction (MI) or cardiogenic shock (p <0.0001 for the 2 comparisons). They were also more likely to have complex lesions (American College of Cardiology/American Heart Association type B2/C), have lesions within a bypass graft, require an intra-aortic balloon pump, receive glycoprotein IIb/IIIa inhibition, and have a longer mean stent length (p <0.0001 for all comparisons). In-hospital outcomes were significantly worse in those patients with transient or persistent no reflow, with increased death, periprocedural MI, renal impairment, and major adverse cardiac events (p <0.0001 for all comparisons). Similarly, transient and persistent no reflow portended worse 30-day clinical outcomes, with a progressive increase in mortality (normal reflow 1.7% vs transient no reflow 5.5% vs persistent no reflow 13.2%, p <0.0001), MI, target vessel revascularization, and major adverse cardiac events (p <0.0001 for all comparisons) compared to patients with normal flow. In conclusion, transient or persistent no reflow complicates approximately 1 in 20 PCIs and results in stepwise increases in in-hospital and 30-day adverse outcomes.
authors.affiliation: Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Chan
authors.forename: Dion
authors.initials: D
authors.lastname: Stub
authors.forename: David J
authors.initials: DJ
authors.lastname: Clark
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.forename: Nick
authors.initials: N
authors.lastname: Andrianopoulos
authors.forename: Angela L
authors.initials: AL
authors.lastname: Brennan
authors.forename: Gishel
authors.initials: G
authors.lastname: New
authors.forename: Alexander
authors.initials: A
authors.lastname: Black
authors.forename: James A
authors.initials: JA
authors.lastname: Shaw
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Dart
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Duffy
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000628:therapy; D058186:Acute Kidney Injury / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D054318:No-Reflow Phenomenon / Q000401:mortality; D017063:Outcome Assessment, Health Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011474:Prosthesis Design; D012042:Registries; D019233:Retreatment; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000453:epidemiology; D015607:Stents; D013318:Stroke Volume
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D003404:Creatinine