Key result
Persistent and transient no-reflow following PCI were associated with increased long-term all-cause mortality (31% and 22%, respectively) compared to normal flow (14%, p<0.0001).
Why the study?
Does transient or persistent no-reflow following PCI increase long-term all-cause mortality compared to normal flow?
Cohort (n=18,281)
Yes
Does transient or persistent no-reflow following PCI increase long-term all-cause mortality compared to normal flow?
Absolute Event Rate: 31% vs 14%
p-value: p=<0.0001
Both transient and persistent no-reflow after PCI are independent predictors of increased long-term all-cause mortality, demonstrating a graded risk.
No-reflow after PCI warrants closer post-procedural monitoring; leaves open whether targeted interventions reduce long-term mortality.
AIMS: The aim of the study was to evaluate long-term outcomes of transient versus persistent no-reflow. METHODS AND RESULTS: A total of 17,547 patients with normal flow post percutaneous coronary intervention (PCI) were compared to 590 patients (3.2%) with transient no-reflow and 144 patients (0.8%) with persistent no-reflow. Long-term all-cause mortality was obtained by linkage with the National Death Index (NDI). No-reflow patients were more likely to have presented with ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest (OHCA) or cardiogenic shock (all p<0.01). Long-term NDI-linked all-cause mortality was highest in patients with persistent no-reflow (31%) followed by transient no-reflow (22%) and normal flow (14%) over a median follow-up of 5.2, 5.5 and 4.5 years, respectively (all p<0.0001). Kaplan-Meier survival estimates demonstrated a graded increase in all-cause mortality from normal flow, to transient to persistent no-reflow (p<0.01), with the highest mortality occurring early (<30 days) in the persistent no-reflow group (p<0.0001). Multivariate Cox proportional hazards modelling identified glomerular filtration rate <30 mL/min, ejection fraction <30%, persistent no-reflow and transient no-reflow as independent predictors of increased hazard for all-cause mortality (all p<0.05). CONCLUSIONS: Transient and persistent no-reflow were associated with a stepwise reduction in long-term survival. The presence of even transient no-reflow appears to be an important predictor of adverse long-term outcome.
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Papapostolou et al. (2018) conducted a cohort in post percutaneous coronary intervention (PCI) (n=18,281). Transient and persistent no-reflow vs. Normal flow was evaluated on Long-term all-cause mortality (p=<0.0001). Persistent and transient no-reflow following PCI were associated with increased long-term all-cause mortality (31% and 22%, respectively) compared to normal flow (14%, p<0.0001).
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