Author + information
- Luis Arcay1,
- Joao Braghiroli2,
- Maria Silva-Chuecos1,
- Vanessa Blumer3,
- Robert Chait1 and
- Gustavo Cardenas4
- 1JFK Medical Center/University of Miami, Atlantis, Florida, United States
- 2Jackson Memorial Hospital/University of Miami, Miami, United States
- 3Jackson Memorial Hospital/University of Miami, Miami, Florida, United States
- 4South Palm Cardiovascular Associates / Delray Medical center, Delray Beach, Florida, United States
In ST segment elevation myocardial infarction (STEMI) primary percutaneous coronary intervention remains the optimal treatment modality to restore normal epicardial coronary artery blood flow. However, despite successful PCI a small, but still significant proportion of patients continue to present inadequate antegrade coronary flow (TIMI 0-2) and consequently lack of intramyocardial reperfusion. This phenomenon is defined as No–Reflow (NRP) and is a well known independent predictor of death and myocardial infarction.
We analyzed 212 consecutive medical charts and coronary angiograms of patients diagnosed with STEMI and who underwent primary PCI in 2012-2013 at JFK medical Center. The analyzed group included 166 patients who met prespecified inclusion and exclusion criteria. Patients were divided into 2 groups: one of No-reflow (n=30) for patients with TIMI 0-2 and other group of normal TIMI 3 flow (n=136). Continuous and categorical variables were compared using Student’s t test and Chi-square test respectively. Univariate analysis was used to determine independent predictors of NRP.
NRP was observed in n=30 (18%) of the patients. Patient’s age, gender, SBP ,EF%, Cr, history of HTN, and DM were similar between the two groups. However, heart rate HR and glucose at admission were significantly higher in the No-reflow group. Hyperglycemia (3.39 CI 1.46-7.88 p0.004), LAD (2.55 CI 1.14-4.88 p0.02) culprit vessel were positive predictors of NRP in contrast with RCA (OR 0.34 CI 0.14-0.81 p0.015) that showed NRP negative statistical correlation.
|Baseline Characteristics of Patients With Normal Flow and No-Reflow Phenomenon.|
|No-Reflow n=30 (18.1%)||Normal Flow n=136 (81.9%)||p|
|Age||66.9 ±11.5||62.4 ±13.6||0.07|
|Female||14 (46.6%)||39 (28.6%)||0.055|
|HR||84.9 ±20.3||72 ±17.21||0.0009|
|Glucose mg/dl||211.4 ±122.6||169.8 ±70.6||0.01|
|Culprit LAD||16 (53.3%)||42 (18.3%)||0.01|
|Culprit RCA||9(30%)||75 (55.14%)||0.01|
|Initial TIMI flow 0||21(70%)||100(73.5%)||0.69|
|Initial TIMI flow 1-2||6(19.96%)||36(26.47%)||0.37|
These results suggest admission hyperglycemia and LAD culprit vessel undergoing PCI for STEMI may have higher prevalence of NRP in contrast with RCA culprit lesions which have a negative predictive factor for NRP. Special consideration should emphasize the need for more specific therapeutic strategies in those at higher risk of NRP.
CORONARY: PCI Outcomes