Usefulness of Transient and Persistent No Reflow to Predict Adverse Clinical Outcomes Following Percutaneous Coronary Intervention
AuthorChan, W; Stub, D; Clark, DJ; Ajani, AE; Andrianopoulos, N; Brennan, AL; New, G; Black, A; Shaw, JA; Reid, CM; ...
Source TitleAMERICAN JOURNAL OF CARDIOLOGY
PublisherEXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
University of Melbourne Author/sBarlis, Peter; Ajani, Andrew; Clark, David; BLACK, ALEXANDER; Chan, William
AffiliationNorth West Academic Centre
Document TypeJournal Article
CitationsChan, W., Stub, D., Clark, D. J., Ajani, A. E., Andrianopoulos, N., Brennan, A. L., New, G., Black, A., Shaw, J. A., Reid, C. M., Dart, A. M. & Duffy, S. J. (2012). Usefulness of Transient and Persistent No Reflow to Predict Adverse Clinical Outcomes Following Percutaneous Coronary Intervention. AMERICAN JOURNAL OF CARDIOLOGY, 109 (4), pp.478-485. https://doi.org/10.1016/j.amjcard.2011.09.037.
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C1 - Journal Articles Refereed
The no reflow phenomenon is reported to occur in >2% of all percutaneous coronary interventions (PCIs) and portends a poor prognosis. We analyzed data from 5,286 consecutive patients who underwent PCI from the Melbourne Interventional Group (MIG) registry from April 2004 through January 2008 who had 30-day follow-up completed. Patients without no reflow (normal reflow, n = 5,031) were compared to 255 (4.8%) with no reflow (n = 217 for transient no reflow, n = 38 for persistent no reflow). Patients with transient or persistent no reflow were more likely to present with ST-elevation myocardial infarction (MI) or cardiogenic shock (p <0.0001 for the 2 comparisons). They were also more likely to have complex lesions (American College of Cardiology/American Heart Association type B2/C), have lesions within a bypass graft, require an intra-aortic balloon pump, receive glycoprotein IIb/IIIa inhibition, and have a longer mean stent length (p <0.0001 for all comparisons). In-hospital outcomes were significantly worse in those patients with transient or persistent no reflow, with increased death, periprocedural MI, renal impairment, and major adverse cardiac events (p <0.0001 for all comparisons). Similarly, transient and persistent no reflow portended worse 30-day clinical outcomes, with a progressive increase in mortality (normal reflow 1.7% vs transient no reflow 5.5% vs persistent no reflow 13.2%, p <0.0001), MI, target vessel revascularization, and major adverse cardiac events (p <0.0001 for all comparisons) compared to patients with normal flow. In conclusion, transient or persistent no reflow complicates approximately 1 in 20 PCIs and results in stepwise increases in in-hospital and 30-day adverse outcomes.
KeywordsCardiology (incl. Cardiovascular Diseases); Cardiovascular System and Diseases
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