The no-reflow phenomenon after primary PCI for STEMI was associated with significantly higher 5-year mortality compared to normal reflow (18.2% vs 9.5%; OR 2.02, 95% CI 1.44-2.82, p<0.001).
Cohort (n=1,406)
Does the no-reflow phenomenon increase 5-year mortality in patients with STEMI treated by primary PCI?
The no-reflow phenomenon after primary PCI for STEMI is a strong, independent predictor of 5-year mortality, providing prognostic value beyond infarct size alone.
Effect estimate: OR 2.02 (95% CI 1.44-2.82)
Absolute Event Rate: 18.2% vs 9.5%
p-value: p=<0.001
OBJECTIVES The objective of this study was to investigate the impact of no-reflow phenomenon on 5-year mortality among patients with acute ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). This impact was also assessed in relation to infarct size. BACKGROUND The impact of no-reflow on long-term mortality in patients with STEMI has been insufficiently studied. METHODS This study included 1,406 patients with STEMI treated by primary PCI. No-reflow was diagnosed using angiographic criteria. Infarct size was measured with single-photon emission computed tomography imaging 7 to 14 days after the acute event. The primary outcome was 5-year mortality. RESULTS The no-reflow phenomenon was diagnosed in 410 patients (29%). Infarct size was 15.0% (6.0% to 29.0%) of the left ventricle in the no-reflow group versus 8.0% (2.0% to 21.0%) of the left ventricle in the reflow group (p < 0.001). There were 132 deaths during follow-up. Of them, 59 deaths occurred among patients with no-reflow and 73 deaths occurred among patients with reflow (Kaplan-Meier estimates of 5-year mortality 18.2% and 9.5%, respectively; odds ratio: 2.02; 95% confidence interval: 1.44 to 2.82; p < 0.001). The Cox proportional hazards model adjusting for infarct size among other variables identified the no-reflow phenomenon as an independent correlate of 5-year mortality (hazard ratio: 1.66; 95% confidence interval: 1.17 to 2.36; p = 0.004). CONCLUSIONS In patients with STEMI treated by primary PCI, no-reflow phenomenon is a strong predictor of 5-year mortality. No-reflow phenomenon after PCI provides prognostic information that is independent of and beyond that provided by infarct size.
Ndrepepa et al. (2010) conducted a cohort in Acute ST-segment elevation myocardial infarction (STEMI) (n=1,406). No-reflow phenomenon vs. Reflow was evaluated on 5-year mortality (OR 2.02, 95% CI 1.44-2.82, p=<0.001). The no-reflow phenomenon after primary PCI for STEMI was associated with significantly higher 5-year mortality compared to normal reflow (18.2% vs 9.5%; OR 2.02, 95% CI 1.44-2.82, p<0.001).