&lt;p&gt;Incidence, Predictors, and Prognosis of Coronary Slow-Flow and No-Reflow Phenomenon in Patients with Chronic Total Occlusion Who Underwent Percutaneous Coronary Intervention&lt;/p&gt;

Wang, Yong; Zhao, Hongwei; Wang, Chengfu; Zhang, Xiaojiao; Tao, Jie; Cui, Chun-sheng; Meng, Qianqian; Zhu, Yu; Luo, Di; Hou, Ai-jie; Liu, Bo

doi:10.2147/tcrm.s233512

Cited by 13 publications

(17 citation statements)

References 28 publications

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“…It was found that stent diameter > 3 mm was associated with higher likelihood of no reflow. Similar reports have also been reported 15,17 .…”

Section: Discussionsupporting

confidence: 91%

Predictors of No-Reflow in Patients undergoing Primary Percutaneous Coronary Intervention for Acute ST Elevation Myocardial Infarction at Tabba Heart Institute Karachi

Nizami¹,

Ahmad²,

Hanif³

2022

PJMHS

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Aim: To determine the predictors of no-reflow in patients undergoing Primary Percutaneous Coronary Intervention (PPCI) for acute ST elevation myocardial infarction (STEMI) at Tabba Heart Institute Karachi. Study duration: The study was carried out from September 2020 to September 2021. Methods: An observational study that was conducted at Tabba heart Institute Karachi. All patients with acute ST elevation myocardial infarction (STEMI) presenting within 12 hours of symptoms who undergoing primary PCI were included in the study. The patients were categorized Angiographically as no –reflow (with Thrombolysis in Myocardial Infarction (TIMI) <3 and reflow (TIMI-3) flow groups. The data regarding age and gender, type of MI, time from symptoms onset, co-morbid conditions like diabetes mellitus, hypertension, smoking, baseline Thrombolysis In Myocardial Infarction Trials (TIMI flow), infarct related artery (IRA), diameter of stent used, and the TIMI flow in IRA after the completion of procedure but before the use of intracoronary adenosine if needed, was recorded on a pre-designed proforma. The data was analyzed using SPSS 20.0. Results: Total 296 patients who underwent primary PCI after acute MI were enrolled in the study. Mean age of the study population was 57±11 years. No reflow was present in 31.4% of patients. No reflow was more common in patients with age more than 60 years, females, symptom onset to primary PCI time of more than 6 hours, LAD infarct, and baseline TIMI flow < 2. Conclusion: During primary PCI, no reflow occurs in a significant percentage of patients and is predictable by a number of factors which should be kept in mind to minimize the incidence of no reflow. Key words: No reflow, acute myocardial infarction, primary PCI

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“…It was found that stent diameter > 3 mm was associated with higher likelihood of no reflow. Similar reports have also been reported 15,17 .…”

Section: Discussionsupporting

confidence: 91%

Predictors of No-Reflow in Patients undergoing Primary Percutaneous Coronary Intervention for Acute ST Elevation Myocardial Infarction at Tabba Heart Institute Karachi

Nizami¹,

Ahmad²,

Hanif³

2022

PJMHS

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“…It is hypothesized that these factors increase procedural difficulty as well as the length of procedure, which in turn increases the probability of PMI. Another study showed that about 16.1% of patients who underwent CTO-PCI had coronary slow-flow and no-reflow phenomenon, and these patients were also more likely to develop PMI [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors and prognosis of PCI-related myocardial injury in chronic total occlusion

Kong

Dai

Luan

et al. 2022

BMC Cardiovasc Disord

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Background Periprocedural myocardial injury (PMI) is associated with major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). However, the incidence predictors and prognosis of PMI in chronic total occlusion (CTO) undergoing PCI remains unclear. Method To evaluate the predictors and prognostic impact of PMI following PCI in patients with CTO. We consecutively enrolled 132 individuals and 8 of whom with procedural failure were excluded in this study. Thus, a total of 124 CTO patients successfully received PCI were included in this study. And patients were divided into the PMI group (n = 42) and the non-PMI group (n = 82) according to their c-TnI levels measured after procedure. The baseline and angiographic characteristics of the two groups were compared. The predictors of PMI and the correlation between PMI and MACE were investigated. Results Overall, PMI occurred in 42 patients (33.9%). Comparing with control group, PMI group had more diabetes (54.8% vs. 31.7%,P = 0.013) and dyslipidemia (54.8% vs. 13.4%, P＜0.001). Also, there were significant differences between the two groups in left ventricular ejection fraction(43.2 ± 7.2 vs 47.2 ± 8.0, P = 0.027), prior myocardial infarction(54.8%vs43.1%, P = 0.020), prior PCI(57.1% vs 22.0%, P＜0.001) and prior CABG(14.3% vs 2.4%, P = 0.011). Also, patients with PMI had more calcified lesions (52.4% vs 24.4%, P = 0.002) and were more likely to have multivessel disease (71.4% vs 35.4%, P＜0.001). In addition, patients in the PMI group had higher J-CTO scores (3.3 ± 1.0 vs 1.9 ± 0.5, P＜0.001) and were more likely to have wire-crossing difficulties (64.3% vs 37.8%, P = 0.005), require more use of retrograde approach (38.1% vs 7.3%, P＜0.001) and have more procedural complications (19.0% vs 2.4%, P = 0.003). In the multivariate analysis, multivessel artery disease (odd ratio [OR], 4.347;95% confidence interval [CI], 1.601– 11.809;P = 0.004), retrograde approach (OR, 4.036; 95%CI, 1.162– 14.020;P = 0.028) and the presence of procedural complications (OR, 16.480;95%CI, 2.515-107.987;P = 0.003) were predictors of PMI. Conclusion The incidence of PMI in CTO patients after PCI was 33.9%. Multivessel artery disease, retrograde approach, and the presence of procedural complications were predictors of PMI after CTO-PCI. Patients who develop PMI tend to have a poorer clinical prognosis and more MACE than those who do not develop PMI.

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“…población estudiada 19 , así como de los métodos usados para detectar el fenómeno de NR. El mecanismo entre la asociación de la función renal y el fenómeno de NR es desconocido, se ha sugerido una posible asociación entre la disfunción renal con la función alterada en las resistencias periféricas de los vasos sanguíneos, lo que condiciona una enfermedad microvascular originada en un desequilibrio en las vías del óxido nítrico 20 .…”

Section: Discussionunclassified

“…De acuerdo con los resultados principales de nuestro estudio, la ER manifestada con una disminución de la tasa de filtración glomerular, un valor de ER KDIGO ≥ 3 y una disminución de la depuración de creatinina; así como un nivel elevado de glucosa y un valor en la clasificación de TIMI basal ≤ 2, se presentaron como predictores independientes en la incidencia del fenómeno de NR en un grupo de pacientes con IAMCEST que fueron tratados con ICP en el noroeste de México. Estos datos discrepan de estudios similares que han sugerido a la edad avanzada, los niveles de CPK, el sitio del infarto y la hiperlipidemia como los principales predictores de la ocurrencia del fenómeno de NR 6 , 17 , las diferencias observadas pueden deberse a variaciones en la población estudiada 19 , así como de los métodos usados para detectar el fenómeno de NR.…”

Section: Discussionunclassified

Predictores de fenómeno de no reflujo en infarto agudo del miocardio con elevación del segmento ST

Ruíz-Avalos¹,

Bazán-Rodríguez²,

Espinoza-Escobar³

et al. 2022

ACM

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Antecedentes: El fenómeno de «no reflujo» (NR) es una de las complicaciones más temidas tras una intervención coronaria percutánea (ICP) en el tratamiento del infarto de miocardio con elevación del segmento ST (IAMCEST) por su elevada morbimortalidad. Objetivo: Describir los factores predictores para el fenómeno de NR en un grupo de sujetos con IAMCEST tratados con ICP. Método: Se estudiaron 103 casos de IAMCEST a los que se les realizó una ICP. Los sujetos se dividieron de acuerdo con la presencia del fenómeno de NR. Se estudió mediante un análisis multivariante la edad, el sexo, presencia de comorbilidades, el peso y otros parámetros clínicos y de laboratorio como predictores del fenómeno de NR. Resultados: En este estudio, el análisis con regresión logística identificó como factores independientes para el desarrollo de fenómeno de NR: el flujo TIMI basal ≤ 2 (razón de momios [OR]: 6.03; intervalo de confianza del 95% [IC 95%]: 0.9-11.8; p = 0.04), estadio enfermedad renal según KDIGO (Kidney Disease: Improving Global Outcomes) ≥ 3 (OR: 3.49; IC 95%: 1.2-2.6; p = 0.02) y nivel de glucosa ≥ 180 mg/dl (OR: 2.61; IC 95%: 1.0-2.4; p = 0.04). Conclusiones: El fenómeno de NR sigue siendo un reto para la morbimortalidad a corto y a largo plazo en el IAMCEST. Los factores identificados pueden ser utilizados para la estratificación de los casos con IAMCEST y riesgo de fenómeno de NR previo a la ICP.

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<p>Incidence, Predictors, and Prognosis of Coronary Slow-Flow and No-Reflow Phenomenon in Patients with Chronic Total Occlusion Who Underwent Percutaneous Coronary Intervention</p>

Cited by 13 publications

References 28 publications

Predictors of No-Reflow in Patients undergoing Primary Percutaneous Coronary Intervention for Acute ST Elevation Myocardial Infarction at Tabba Heart Institute Karachi

Predictors of No-Reflow in Patients undergoing Primary Percutaneous Coronary Intervention for Acute ST Elevation Myocardial Infarction at Tabba Heart Institute Karachi

Predictors and prognosis of PCI-related myocardial injury in chronic total occlusion

Predictores de fenómeno de no reflujo en infarto agudo del miocardio con elevación del segmento ST

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