title: Predictive Value of the No-Reflow Phenomenon and Epicardial Adipose Tissue for Clinical Outcomes After Primary Percutaneous Coronary Intervention.
abstract: BACKGROUND
  The determinants of clinical outcomes in patients with acute ST-elevation myocardial infarction (STEMI) are still being debated. The aim of this study was to investigate the prognostic value of the no-reflow phenomenon and epicardial adipose tissue (EAT) thickness for clinical outcomes in patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI.
  
  
  METHODS
  The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) who underwent successful pPCI. Patients were divided into two groups according to the occurrence of the no-reflow phenomenon and further subdivided according to the tertile of EAT thickness (Group I <5.1 mm, Group II ≥5.1 mm). We assessed the composite and separate occurrence of major adverse cardiac events.
  
  
  RESULTS
  Throughout the 3-year follow up, the number of admissions for heart failure was significantly higher in patients with no-reflow (n=5 [20%] vs. n=1 [1%], p=0.003) and in female patients (n=4 [26%] vs. n=2 [2%], p=0.004). In the subgroup analysis, group I patients with no-reflow showed a higher frequency of admission for heart failure (n=4 [44%] vs. n=1 [6%], p=0.04). However, multivariate logistic regression analysis demonstrated that only no-reflow and female sex independently predicted admission for heart failure (OR: 19.3, 95%CI: 1.4-269.7, p=0.03, and OR: 24.9, 95%CI: 2.2-288.8, p=0.01, respectively).
  
  
  CONCLUSIONS
  No-reflow and female sex are independent predictors of admission for heart failure in the longterm follow up of patients with STEMI. However, EAT thickness is not associated with clinical outcomes after pPCI.
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Aycan Esen
authors.initials: AE
authors.lastname: Zencirci
authors.forename: Erturul
authors.initials: E
authors.lastname: Zencirci
authors.forename: Aleks
authors.initials: A
authors.lastname: Değirmencioğlu
authors.forename: Aysun
authors.initials: A
authors.lastname: Erdem
authors.forename: Gültekin
authors.initials: G
authors.lastname: Karakuş
authors.forename: Kivilcim
authors.initials: K
authors.lastname: Özden
authors.forename: Fatma
authors.initials: F
authors.lastname: Karadeniz
authors.forename: Ali
authors.initials: A
authors.lastname: Buturak
authors.forename: Erdal
authors.initials: E
authors.lastname: Belen
authors.forename: Fatih
authors.initials: F
authors.lastname: Tipi
authors.forename: Mehmet
authors.initials: M
authors.lastname: Eren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000473:pathology* / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000601:surgery*; D054318:No-Reflow Phenomenon / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D062645:Percutaneous Coronary Intervention; D010496:Pericardium / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014463:Ultrasonography