title: [A high-volume single center experience of no-reflow post-percutaneous coronary intervention].
abstract: BACKGROUND
  The no-reflow (NR) phenomenon is frequent in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). However, its real incidence and prognostic significance, so far derived from relatively small patient cohorts, remain poorly defined.
  
  
  METHODS
  We have retrospectively analyzed 19 290 consecutive PCI performed at our hospital between January 1998 and November 2010. NR was defined as a TIMI flow ≤2 at the end of the PCI.
  
  
  RESULTS
  In the 1257 patients with STEMI, NR occurred in 9.4% of cases and was more common when the left anterior descending coronary artery was the culprit vessel. STEMI-NR patients had longer ischemic times and more frequently multivessel disease. In the STEMI-NR group, glycoprotein IIb/IIIa inhibitors were used in 60.2%, nitroprusside in 39.6%, thrombus aspiration in 10.7% and adenosine in 8.7%. In the remaining 18033 patients without STEMI undergoing PCI, the NR phenomenon occurred only in 0.2% of cases. STEMI-NR patients had lower left ventricular ejection fraction at discharge (50.3 ± 7.2 vs 44.9 ± 8.4%; p<0.01) and showed higher rates of adverse events (death, non-fatal myocardial infarction, coronary revascularization, new hospital admission for heart failure: 67.8 vs 36.9%, p=0.001), death (25.4 vs 13.2%, p<0.01), myocardial infarction (13.6 vs 4.8%, p<0.01) and hospitalizations for heart failure (13.6 vs 4.8%, p<0.001).
  
  
  CONCLUSIONS
  Our data, derived from a large cohort of patients from a single center, allow a more correct estimate of the occurrence and prognostic significance of NR. The NR phenomenon is more common in STEMI patients undergoing primary PCI and has an important negative prognostic value.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Durante
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pizzetti
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Camici
mesh_terms: D000241:Adenosine / Q000627:therapeutic use; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D009599:Nitroprusside / Q000627:therapeutic use; D054318:No-Reflow Phenomenon / Q000453:epidemiology*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D016277:Ventricular Function, Left
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D009599:Nitroprusside; D000241:Adenosine