Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Long-Term Clinical Outcomes of Transient and Persistent No Reflow Phenomena following Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

  • Kim, Min Chul (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Cho, Jae Yeong (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Jeong, Hae Chang (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Lee, Ki Hong (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Park, Keun Ho (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Sim, Doo Sun (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Yoon, Nam Sik (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Youn, Hyun Joo (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Kim, Kye Hun (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Hong, Young Joon (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Park, Hyung Wook (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Kim, Ju Han (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Jeong, Myung Ho (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Cho, Jeong Gwan (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Park, Jong Chun (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Seung, Ki-Bae (Department of Cardiology, Seoul St Mary's Hospital, The Catholic University School of Medicine) ;
  • Chang, Kiyuk (Department of Cardiology, Seoul St Mary's Hospital, The Catholic University School of Medicine) ;
  • Ahn, Youngkeun (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine)
  • Received : 2015.09.05
  • Accepted : 2015.12.08
  • Published : 2016.07.30
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Abstract

Background and Objectives: There is limited information on the transient or persistent no reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Subjects and Methods: The study analyzed 4329 patients with AMI from a Korean multicenter registry who underwent PCI using coronary stents (2668 ST-elevation and 1661 non-ST-elevation myocardial infarction [MI] patients): 4071 patients without any no reflow, 213 with transient no reflow (no reflow with final thrombolysis in myocardial infarction [TIMI] flow grade 3), and 45 with persistent no reflow (no reflow with final TIMI flow grade${\leq}2$). The primary endpoint was all-cause mortality during 3-year follow-up. We also analyzed the incidence of cardiac mortality, non-fatal MI, re-hospitalization due to heart failure, target vessel revascularization, and stent thrombosis. Results: The persistent no reflow group was associated with higher all-cause mortality (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.08-3.65, p=0.028) and cardiac mortality (HR 3.28, 95% CI 1.54-6.95, p=0.002) compared with the normal reflow group. Transient no reflow increased all-cause mortality only when compared with normal reflow group (HR 1.58, 95% CI 1.11-2.24, p=0.010). When comparing transient and persistent no reflow, persistent no reflow was associated with increased all-cause mortality (46.7 vs. 24.4%, log rank p=0.033). Conclusion: The persistent no reflow phenomenon was associated with a poor in-hospital outcome and increased long-term mortality mainly driven by increased cardiac mortality compared to the transient no reflow phenomenon or normal reflow.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea, Ministry for Health & Welfare

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