Author + information
- Received May 6, 1999
- Revision received March 27, 2000
- Accepted June 1, 2000
- Published online October 1, 2000.
- Itsuro Morishima, MD∗,* (, )
- Takahito Sone, MD‡,
- Kenji Okumura, MD∗,
- Hideyuki Tsuboi, MD‡,
- Junichiro Kondo, MD‡,
- Hiroaki Mukawa, MD‡,
- Hideo Matsui, MD∗,
- Yukio Toki, MD∗,
- Takayuki Ito, MD† and
- Tetsuo Hayakawa, MD, PhD∗
- ↵*Reprint requests and correspondence: Itsuro Morishima, Internal Medicine II, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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).
Angiographic no-reflow phenomenon, a reduced coronary antegrade flow (Thrombolysis in Myocardial Infarction [TIMI] flow grade ≤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.
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.
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.
Angiographic no-reflow phenomenon strongly predicts long-term cardiac complications after AMI; these complications are possibly associated with LV remodeling.
- Received May 6, 1999.
- Revision received March 27, 2000.
- Accepted June 1, 2000.
- American College of Cardiology