Clinical and procedural predictors of no-reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention

Zhou, Hua; He, Xiaoyan; Zhuang, Songlin; Wang, Juan; Liu, Yan; Qi, Weigang; Yao, Yian; Liu, Xuebo

doi:10.5847/wjem.j.issn.1920-8642.2014.02.003

Cited by 66 publications

(60 citation statements)

References 26 publications

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“…No-reflow after PCI is a common complication, which mainly refers to the process in which blood supply to the tissues cannot be immediately restored after coronary blood flow recanalization (10,11). The specific mechanism for its occurrence is still not entirely clear, and it is believed at present that PCI with no reflow is related to micro-distal embolization, ischemia and reperfusion injury susceptibility.…”

Section: Discussionmentioning

confidence: 99%

“…TIMI (10). The myocardial perfusion grading method was defined as: 0, no myocardial filling and no evacuation; 1, a slow myocardial filling, with very slow emptying, and a long contrast agent retention time that was still visible until the next angiography (~30 sec); 2, partial myocardial filling, slow emptying myocardial blush which was still strong at the end of the washout period (i.e., after three cardiac cycles of the washout period); and 3, normal myocardial filling and emptying that were rapid, and in which the contrast agent had completely disappeared or rarely left at the end of the washout.…”

Section: Methodsmentioning

confidence: 99%

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Clinical effect of preoperative high-dose atorvastatin against no-reflow after PCI

Liu

Zou

Jiang

et al. 2016

Experimental and Therapeutic Medicine

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The aim of the present study was to evaluate the use of preoperative high-dose atorvastatin to prevent the no-reflow phenomenon after percutaneous coronary intervention (PCI). A total of 138 patients with ST-segment elevation myocardial infarction, admitted from March 2014 to January 2015, were enrolled and randomly divided into 3 groups of 46 individuals each. The groups included a control group in which patients were not treated with atorvastatin before PCI; a conventional-dose atorvastatin treatment group in which patients received a single dose of 20 mg at bedtime one day prior to PCI; and a high-dose atorvastatin treatment group in which patients were treated with 40 mg divided in two doses the day before PCI. The treatment effects were assessed by re-examining the echocardiography, high-sensitivity C-reactive protein and brain natriuretic peptide (BNP) levels after the PCI. The follow-up examinations included determinations of ultrasound imaging indicators and the contact with patients was maintained for a whole year. The CTFC (frame), pro-BNP, CK-MB peak and WMSI levels of the patients in the high-dose treatment group were significantly lower than those in the conventional dose or the control group. Trombolysis in myocardial infarction ≤2 and myocardial blush grade ≤1 levels were significantly lower than those in the conventional dose group (P=0.01) or those in the control group (P=0.01), although the echocardiographic indicators of the three groups were not significantly different (P<0.05). Nevertheless, it was found that there were significantly fewer adverse cardiovascular events in the high-dose group (P<0.05 in both cases). During the follow-up period, thromboembolism and restenosis were most infrequent in the high-dose atorvastatin group. Based on our findings the oral administration of high-dose atorvastatin before bedtime, one day before the procedure, can effectively prevent no-reflow cases, reduce adverse events and improve the long-term prognosis for acute coronary syndrome patients after PCI.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clinical effect of preoperative high-dose atorvastatin against no-reflow after PCI

Liu

Zou

Jiang

et al. 2016

Experimental and Therapeutic Medicine

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“…Similar to the study of Yip et al [24], the no-reflow was lower in those with reperfusion less than 4 hours among patients with AMI who had a high thrombus burden. The underlying mechanism is complex; prolonged ischemia leads to edema of distal capillary beds, swelling of myocardial cells, neutrophil plugging, alterations of capillary integrity, and disruption of microvascular bed, contributing to the pathogenesis of no-reflow [25]. …”

Section: Discussionmentioning

confidence: 99%

Clinic Predictive Factors for Insufficient Myocardial Reperfusion in ST-Segment Elevation Myocardial Infarction Patients Treated with Selective Aspiration Thrombectomy during Primary Percutaneous Coronary Intervention

Tian

Liu

Song

et al. 2016

BioMed Research International

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Background. Insufficient data are available on the potential benefit of selective aspiration and clinical predictors for no-reflow in STEMI patients undergoing primary percutaneous coronary intervention (PPCI) adjunct with aspiration thrombectomy. Objective. The aim of our study was to investigate clinical predictors for insufficient reperfusion in patients with high thrombus burden treated with PPCI and manual aspiration thrombectomy. Methods. From January 2011 till December 2015, 277 STEMI patients undergoing manual aspiration thrombectomy and PPCI were selected and 202 patients with a Thrombolysis in Myocardial Infarction (TIMI) thrombus grade 4~5 were eventually involved in our study. According to a cTFC value, patients were divided into Group I (cTFC > 40), namely, insufficient reperfusion group; Group II (cTFC ≤ 40), namely, sufficient reperfusion group. Results. Univariate analysis showed that hypertension, multivessel disease, time from symptom to PCI (≧4.8 hours), and postaspiration cTFC > 40 were negative predictors for insufficient reperfusion. After multivariate adjustment, age ≧ 60 years, hypertension, time from symptom to PCI (≧4.8 hours), and postaspiration cTFC > 40 were independently associated with insufficient reperfusion in STEMI patients treated with manual aspiration thrombectomy. Upfront intracoronary GP IIb/IIIa inhibitor (Tirofiban) was positively associated with improved myocardial reperfusion. Conclusion. Fully identifying risk factors will help to improve the effectiveness of selective thrombus aspiration.

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“…Domestic DESs have accounted for over 60% of total stents used in our hospital. Some studies [11][12][13][14] compared the clinical effi cacy of domestic DESs with imported DESs, but they had a small sample size, limited to single stent comparison and specifi c patients. The present study enrolled the patients with ACS who underwent successfully PCI from July 2009 to December 2010 in our hospital, including use of domestic DESs available at that time.…”

Section: Discussionmentioning

confidence: 99%

Domestic versus imported drug-eluting stents for the treatment of patients with acute coronary syndrome

Yao

Sun

Wan

et al. 2014

World Journal of Emergency Medicine

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BACKGROUND:The application of coronary stents, especially drug-eluting stents (DESs), has made percutaneous coronary intervention (PCI) one of important therapeutic methods for CHD. DES has reduced the in-stent restenosis to 5%-9% and signifi cantly improved the long-term prognosis of patients with CHD. The study aimed to investigate the long-term effi cacy and safety of domestic drugeluting stents (DESs) in patients with acute coronary syndrome (ACS).METHODS: All patients with ACS who had undergone successful percutaneous coronary intervention (PCI) in the First Affi liated Hospital of Zhengzhou University from July 2009 to December 2010 were included in this study. Patients were excluded from the study if they were implanted with bare metal stents or different stents (domestic and imported DESs) simultaneously. The included patients were divided into two groups according to different stents implanted: domestic DESs and imported DESs. RESULTS:In the 1 683 patients of this study, 1 558 (92.6%) patients were followed up successfully for an average of (29.1±5.9) months. 130 (8.3%) patients had major adverse cardiovascular events (MACEs), including cardiac death in 32 (2.1%) patients, recurrent myocardial infarction in 16 (1%), and revascularization in 94 (6%). The rates of cardiac death, recurrent myocardial infarction, revascularization, in-stent restenosis, stent thrombosis and other MACEs were not signifi cantly different between the two groups (all P>0.05). Multivarite logistic regression revealed that diabetes mellitus (OR=1.75, 95%CI: 1.09-2.82, P=0.021), vascular numbers of PCI (OR=2.16, P=0.09) and PCI with left main lesion (OR=9.47, P=0.01) were independent prognostic factors of MACEs. The Kaplan-Meier method revealed that there was no significant difference in cumulative survival rates and survival rates free from clinical events between the two groups (all P>0.05). CONCLUSIONS:The incidences of clinical events and cumulative survival rates are not statistically different between domestic DESs and imported DESs. Domestic DES is effective and safe in the treatment of patients with ACS.

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Clinical and procedural predictors of no-reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention

Cited by 66 publications

References 26 publications

Clinical effect of preoperative high-dose atorvastatin against no-reflow after PCI

Clinical effect of preoperative high-dose atorvastatin against no-reflow after PCI

Clinic Predictive Factors for Insufficient Myocardial Reperfusion in ST-Segment Elevation Myocardial Infarction Patients Treated with Selective Aspiration Thrombectomy during Primary Percutaneous Coronary Intervention

Domestic versus imported drug-eluting stents for the treatment of patients with acute coronary syndrome

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