Clinical Predictors of No-Reflow
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- Category: Vol. 85, June 2017
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Clinical Predictors of No-Reflow, IBRAHIM MAHMOUD, MOHAMED HOSNY, MOHAMED FAWZY, DALIA RAGAB and HATEM EL-ATROUSH
Abstract
Background: The no-reflow phenomenon in the setting of primary coronary intervention for Acute Myocardial Inf-arction (AMI) is relatively common and is associated with adverse outcomes. The detection of clinical variables associated with this phenomenon before the procedure might help to adopt preventive measures and thus improve the results.
Objective: The aim of this study was to identify clinical predictors of the no-reflow phenomenon in the setting of percutaneous coronary intervention for ST-segment elevation acute myocardial infarction, prior to the procedure.
Methods: A total of 760 patients with acute ST Segment Myocardial Infarction (STEMI) within 24 hour since onset of symptoms treated with primary Percutaneous Coronary Intervention (pPCI) were analyzed. No-reflow was considered as the presence of TIMI grade £2 flow immediately after the procedure in the absence of residual stenosis. Demographic variables, coronary risk factors, family history and delay to reperfusion were analyzed. Multivariate logistic regression was used to determine the independent prognostic value of the variables associated with no-reflow.
Results: The no-reflow phenomenon was present in 103 patients (13.6%). There were significant differences among the noreflow and normal flow groups with respect to age (66.5±6.9 years vs. 52.4±8.3 years respectively, p: <0.001.), basal glucose levels (275.0±76.9mg/dl versus 144.2±70.3mg/dl respectively p-value <0.001), and the incidences of diabetes mellitus (92% diabetic pts versus 25.7% respectively, p: <0.001), Killip class (3.1±0.7 vs. 1.2±0.5, p-value <.001), onset of presentation (7.8±2.4 hours vs. 3.4±1.6 hours, p-value <.001), admission random blood glucose (275.0±76.9 versus 144.270.3, p-value <.001) and previous use of statins. There were increasing rates of culprit left anterior descending lesion (p<.001). Multivariate analysis identified age >57 years, admission random blood glucose and delay to reperfusion >5.5 hours as independent predictors of no-reflow.
Conclusion: Advanced age, admission random blood glucose and delay to reperfusion were independent clinical predictors of no-reflow. The confirmation of these findings in prospective studies might allow the implementation of strategies to prevent this phenomenon and eventually improve the long-term clinical outcomes.