Author + information
- Mohamed Abo Bakra,b,
- Hisham Samir Roshdya,b,
- Mohamed Ibrahim Mostafa Elawadia,b and
- Mohamed Hossam Eldein Elshaera,b
Background: No-reflow phenomenon is the most striking example of myocardial reperfusion clinical failure. It caused by a lack of adequate blood flow in tissues after successful recanalization of infarct-related artery and was of multifactorial nature. Patients with «no-reflow» have highly increased risk of complications such as reduced systolic function, heart muscle remodeling, dilatation, left ventricular aneurysm and death. Predisposition for «no-reflow» might be associated with a number of local and systemic factors.
Methods: The study included 488 consecutive patients; with Acute STEMI underwent primary PCI. The patients were divided into a study group (400 patients), and a validation group (88 patients). The study group patients were subdivided into 2 subgroups, No reflow Group (N) 128 patients with (TIMI flow ≤2), and Reflow group (R) 272 patients with (TIMI flow 3), and different demographic, clinical, ECG, echo and angiographical data were collected and compared between the two subgroups. Relevant variables were entered in forward binary logistic regression analysis, a weighted score was constructed. The score was validated on the validation group.
Results: A 8 variable scoring system was constructed as follows : age above 60years old 1 point, delayed reperfusion time more than 4hrs 2 points, large luminal diameter ≥ 2.8mm 2 points, long target lesion ≥ 20mm 4 points, high thrombus burden 1 point, initial TIMI flow ≤ 1 is 3 points, positive Ck-Mb on admission 2 points and elevated D-dimer ≥ 500ng/ml 1 point, with final total score = 16 points. A ROC analysis was per-formed for the scored patients showing that all patients scoring 10 points or more are most likely to have no reflow phenomenon, test sensitivity was 86% and specificity was 73 %, P < 0.001. Score validation revealed a sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 80%, 92%, 86%, 89% and 85% respectively, in detecting no reflow during primary PCI in patients presented by acute STEMI.
Conclusions: The current study suggested a weighted scoring system, to predict the development of no-reflow phenomenon during primary PCI
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Revascularization and Myocardial Preservation in Acute and Stable Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1165-313
- 2017 American College of Cardiology Foundation