Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction.

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    • Source:
      Publisher: Elsevier Biomedical Country of Publication: United States NLM ID: 8301365 Publication Model: Print Cited Medium: Print ISSN: 0735-1097 (Print) Linking ISSN: 07351097 NLM ISO Abbreviation: J Am Coll Cardiol Subsets: MEDLINE
    • Publication Information:
      Original Publication: [New York, N.Y.] : Elsevier Biomedical, [c1983-
    • Subject Terms:
      Coronary Angiography*/methods; Angioplasty, Balloon, Coronary/*adverse effects ; Coronary Circulation/*physiology ; Myocardial Infarction/*therapy ; Ventricular Function, Left/*physiology; Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary/mortality ; Cause of Death ; Cineangiography ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Japan/epidemiology ; Male ; Middle Aged ; Myocardial Infarction/diagnostic imaging ; Myocardial Infarction/mortality ; Myocardial Infarction/physiopathology ; Retrospective Studies ; Risk Factors ; Stroke Volume ; Survival Rate
    • Abstract:
      Objectives: We sought to elucidate the long-term prognostic importance of angiographic no-reflow phenomenon after percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI).
      Background: Angiographic no-reflow phenomenon, a reduced coronary antegrade flow (Thrombolysis in Myocardial Infarction [TIMI] flow grade < or =2) without mechanical obstruction after recanalization, predicts poor left ventricular (LV) functional recovery and survival in the early phase of AMI. We hypothesized that angiographic no-reflow phenomenon also predicts long-term clinical outcome.
      Methods: We studied 120 consecutive patients with their first AMI treated by PTCA without flow-restricting lesions. The patients were classified as either no-reflow (n = 30) or reflow (TIMI-3) (n = 90) based on post-PTCA cineangiograms to follow up (5.8 +/- 1.2 years) for cardiac death and nonfatal events.
      Results: Patients with no-reflow had congestive heart failure (p < 0.0001), malignant arrhythmia (p = 0.038), and cardiac death (p = 0.002) more often than did those with reflow. Kaplan-Meier curves showed lower cardiac survival and cardiac event-free survival (p < 0.0001) in patients with no-reflow than in those with reflow. Multivariate analyses disclosed that no-reflow phenomenon was an independent predictor of long-term cardiac death (relative risk [RR] 5.25, 95% confidence interval [CI] 1.85 to 14.9, p = 0.002) and cardiac events (RR 3.71, 95% CI 1.79 to 7.69, p = 0.0004). At follow-up, survivors with no-reflow had higher end-diastolic and end-systolic LV volume indices and plasma brain natriuretic peptide levels, and lower LV ejection fractions (p = 0.0002, p < 0.0001, p = 0.002, p < 0.0001, respectively) than did those with reflow, indicating that no-reflow may be involved in LV remodeling.
      Conclusions: Angiographic no-reflow phenomenon strongly predicts long-term cardiac complications after AMI; these complications are possibly associated with LV remodeling.
    • Publication Date:
      Date Created: 20001012 Date Completed: 20001026 Latest Revision: 20220409
    • Publication Date:
      20221213
    • Accession Number:
      10.1016/s0735-1097(00)00865-2
    • Accession Number:
      11028471