Key result
Lower baseline eGFR predicts ~15-fold higher odds of angiographic no-reflow during primary STEMI PCI.
Why the study?
No-reflow is a frequent complication during PCI for STEMI, and data are limited on the impact of baseline renal dysfunction on no-reflow and short-term outcomes in patients undergoing manual thrombus aspiration.
Does baseline renal dysfunction predict the no-reflow phenomenon in STEMI patients undergoing primary PCI with manual thrombus aspiration?
Cohort (n=94)
Does baseline renal dysfunction predict the no-reflow phenomenon in STEMI patients undergoing primary PCI with manual thrombus aspiration?
Baseline renal dysfunction is a strong independent predictor of angiographic no-reflow in STEMI patients undergoing primary PCI with thrombus aspiration.
Renal dysfunction may flag higher no-reflow risk during STEMI primary PCI; leaves open whether renal optimization alters outcomes.
BACKGROUND: No-reflow is a frequent complication during percutaneous coronary intervention (PCI) for acute ST segment elevation myocardial infarction (STEMI). Available data is limited regarding its impact on short-term outcomes in patients undergoing manual thrombus aspiration. Renal impairment is also associated with higher complication rates in STEMI. Herein, we aimed to evaluate the impact of baseline renal dysfunction on the no- reflow phenomenon and the association of no-reflow phenomenon with early clinical outcomes. METHODS: A total of 94 consecutive STEMI patients who underwent primary stent-based PCI and thrombus aspiration were enrolled. No-reflow was established by the use of angiographic and electrocardiographic reperfusion criteria, respectively. Additionally angiographic and clinical follow-up data were also recorded. RESULTS: In our study, the no-reflow phenomenon was observed in 10 patients (11%) angiographically and in 23 patients (24%) electrocardiographically. Whereas, the the estimated glomerular filtration rate (eGFR) [odds ratio (OR) 10.4], hypertension (OR 6.2), previous MI (OR 6.5), previous PCI history, (OR 4.2), predilatation (OR 7.2), final balloon pressure (OR 0.9) were found to be the significant predictors of angiographic no-reflow, only reperfusion time was the predictor of electrocardiographic no-reflow (OR 1.12) at univariate analysis. After adjustment, lower eGFR (OR 14.8) was found to be the independent predictor for angiographic no-reflow. In-hospital mortality was more common in patients with either no-reflow condition separately. CONCLUSIONS: Longer ischemic time and lower initial eGFR values were associated with no-reflow phenomenon. Irrespective of poor reperfusion criteria, no-reflow phenomenon is associated with in-hospital outcome. Future efforts should be made to reduce the incidence of no-reflow especially in patients with lower initial eGFR values.
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Şensoy et al. (2016) conducted a cohort in Acute ST segment elevation myocardial infarction (STEMI) (n=94). Lower estimated glomerular filtration rate (eGFR) vs. Higher eGFR was evaluated on Angiographic no-reflow (OR 14.8). Lower baseline estimated glomerular filtration rate was an independent predictor of angiographic no-reflow (OR 14.8) in STEMI patients undergoing primary PCI with thrombus aspiration.
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