title: The impact of no-reflow phenomena after primary percutaneous coronary intervention: a time-dependent analysis of mortality.
abstract: BACKGROUND
  The no-reflow phenomenon is a potential complication of primary percutaneous coronary intervention (PCI). Predictors of the no-reflow phenomenon and the impact on long-term mortality remain unclear.
  
  
  METHODS
  Two thousand and seventeen patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary PCI were consecutively enrolled in the multicentre Acute Myocardial Infarction registry of Korea. The no-reflow phenomenon was diagnosed on the basis of angiographic criteria. The primary outcome was all-cause mortality.
  
  
  RESULTS
  The no-reflow phenomenon was diagnosed in 262 patients (13.0%). Independent predictors of no-reflow were older age, high Killip class, reduced pre-PCI thrombolysis in myocardial infarction flow grade, and longer stent length in the culprit vessel. During a median follow-up period of 4.1 years (interquartile range: 3.0-5.2 years), patients with no-reflow showed a higher rate of mortality than that observed in patients with reflow (30.2 vs. 18.3%, P<0.001). The multivariate Cox proportional hazards model identified the no-reflow phenomenon as an independent correlate of long-term mortality [adjusted hazard ratio (HR): 1.45; 95% confidence interval (CI): 1.12-1.86; P=0.004]. Time period-specific analyses demonstrated that the association between no-reflow and mortality was significant and stronger for short-term (<30 days) mortality (adjusted HR: 3.11; 95% CI: 1.91-5.05; P<0.001) but was not significant for longer-term mortality (≥30 days; adjusted HR: 1.12; 95% CI: 0.82-1.52; P=0.47).
  
  
  CONCLUSIONS
  In patients with STEMI who had undergone primary PCI, the no-reflow phenomenon was an independent predictor of short-term but not long-term mortality.
authors.affiliation: aDepartment of Internal Medicine, Division of Cardiology, Cardiovascular Center, Seoul St. Mary's Hospital bDivision of Cardiology, St. Paul's Hospital, Seoul cDivision of Cardiology, Incheon St. Mary's Hospital, Incheon dDivision of Cardiology, Uijeongbu St. Mary's Hospital, Uijeongbu eDivision of Cardiology, Daejeon St. Mary's Hospital, Daejeon fDivision of Cardiology, Yeouido St. Mary's Hospital, Yeouido gDivision of Cardiology, Bucheon St. Mary's Hospital, Bucheon hDivision of Cardiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon iDivision of Cardiology, Chonnam National University Hospital, Chonnam National University, Gwangju, Korea.
authors.forename: Eun Ho
authors.initials: EH
authors.lastname: Choo
authors.forename: Pum Joon
authors.initials: PJ
authors.lastname: Kim
authors.forename: Kiyuk
authors.initials: K
authors.lastname: Chang
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Doo Soo
authors.initials: DS
authors.lastname: Jeon
authors.forename: Jong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Dong Bin
authors.initials: DB
authors.lastname: Kim
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Her
authors.forename: Chul Soo
authors.initials: CS
authors.lastname: Park
authors.forename: Hee Yeol
authors.initials: HY
authors.lastname: Kim
authors.forename: Ki-Dong
authors.initials: KD
authors.lastname: Yoo
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome