title: The no-reflow phenomenon in the young and in the elderly.
abstract: BACKGROUND
  The objectives of this study were to evaluate the incidence of no-reflow as independent predictor of adverse events and to assess whether baseline pre-procedural treatment options may affect clinical outcomes.
  
  
  METHODS
  Data were derived from the ISACS-TC registry (NCT01218776) from October 2010 to January 2015. No-reflow was defined as post-PCI TIMI flow grades 0-1, in the absence of post-procedural significant (≥25%) residual stenosis, abrupt vessel closure, dissection, perforation, thrombus of the original target lesion, or epicardial spasm. The outcome measure was in-hospital mortality.
  
  
  RESULTS
  No-reflow was identified in 128 of 5997 patients who have undergone PCI (2.1%). On multivariate analysis, patients with no-reflow were more likely to be older (OR: 1.20, 95% CI: 1.01-1.44), to have a history of hypercholesterolemia (OR: 1.95, 95% CI: 1.31-2.91) and to be admitted with a diagnosis of STEMI (OR: 2.96, 95% CI: 1.85-4.72). Angiographic characteristics associated with no-reflow phenomenon were: stenosis ≥50% of the right coronary artery, presence of multivessel disease and pre-procedural TIMI blood flow grades 0-1. No-reflow was highly predictive of in-hospital mortality (17.2% vs. 4.2%; adjusted OR: 4.60, 95% CI: 2.61-8.09). Administration of pre-procedural unfractioned heparin or 600mg clopidogrel loading dose was associated with less incidence of no-reflow (OR: 0.65, 95% CI: 0.43-0.99 and 0.61, 95% CI: 0.37-1.00, respectively). Aspirin, enoxaparin, and 300mg clopidogrel loading dose, did not significantly impact the occurrence of the no-reflow.
  
  
  CONCLUSIONS
  We found that pre-procedural administration of 600mg loading dose of clopidogrel and/or unfractioned heparin is associated with reduced incidence of no-reflow.
authors: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
authors: Edina
authors: E
authors: Cenko
authors: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
authors: Beatrice
authors: B
authors: Ricci
authors: University Clinic of Cardiology, Medical Faculty, University of St. Cyril & Methodius, Skopje, Macedonia.
authors: Sasko
authors: S
authors: Kedev
authors: University Clinic of Cardiology, Medical Faculty, University of St. Cyril & Methodius, Skopje, Macedonia.
authors: Oliver
authors: O
authors: Kalpak
authors: Department of Cardiology, Clinical Emergency Hospital Bucharest, Bucharest, Romania.
authors: Lucian
authors: L
authors: Câlmâc
authors: Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors: Zorana
authors: Z
authors: Vasiljevic
authors: Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro.
authors: Božidarka
authors: B
authors: Knežević
authors: Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors: Mirza
authors: M
authors: Dilic
authors: Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia.
authors: Davor
authors: D
authors: Miličić
authors: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
authors: Olivia
authors: O
authors: Manfrini
authors: Institute of Natural Sciences, University of Physical Education, Budapest H-1123, Hungary.
authors: Akos
authors: A
authors: Koller
authors: Department of Cardiology, Clinical Emergency Hospital Bucharest, Bucharest, Romania; Bucharest University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
authors: Maria
authors: M
authors: Dorobantu
authors: Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Institute Carlos III, Autonomous University of Barcelona, Barcelona, Spain.
authors: Lina
authors: L
authors: Badimon
authors: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy. Electronic address: raffaele.bugiardini@unibo.it.
authors: Raffaele
authors: R
authors: Bugiardini
mesh_terms: D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D054318:No-Reflow Phenomenon / Q000453:epidemiology* / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Acute coronary syndromes; Mortality; No-reflow; Percutaneous coronary intervention; Therapy