The no-reflow phenomenon in the young and in the elderly

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• 作者：Edina Cenko^a ; Beatrice Ricci^a ; Sasko Kedev^b ; Oliver Kalpak^b ; Lucian Câ ; lmâ ; c^c ; Zorana Vasiljevic^d ; Božidarka Knežević^e ; Mirza Dilic^f ; Davor Miličić^g ; Olivia Manfrini^a ; Akos Koller^h ; Maria Dorobantu^c ; ⁱ ; Lina Badimon^j ; Raffaele Bugiardini^a ; ^{raffaele.bugiardini@unibo.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：No-reflow ; Acute coronary syndromes ; Mortality ; Therapy ; Percutaneous coronary intervention
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：222
• 期：Complete
• 页码：1122-1128
• 全文大小：533 K

文摘

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 600 mg 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 300 mg clopidogrel loading dose, did not significantly impact the occurrence of the no-reflow.

Conclusions

We found that pre-procedural administration of 600 mg loading dose of clopidogrel and/or unfractioned heparin is associated with reduced incidence of no-reflow.