Clinical and procedural predictors of no―reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention.doc

Clinical and procedural predictors of no―reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention 　　BACKGROUND： The treatment of acute myocardial infarction （AMI） is thought to restore antegrade blood flow in the infarct-related artery （IRA） and minimize ischemic damage to the myocardium as soon as possible. The present study aimed to identify possible clinical predictors for no-reflow in patients with AMI after primary percutaneous coronary intervention （PCI）. METHODS： A total of 312 consecutive patients with AMI who had been treated from January 2008 to December 2010 at the Cardiology Department of East Hospital， Tongji University School of Medicine were enrolled in this study. Inclusion criteria were： （i） patients underwent successfully primary PCI within 12 hours after the appearance of symptoms； or （ii） patients with ischemic chest pain for more than 12 hours after a successful primary PCI within 24 hours after appearance of symptoms. Exculsion criteria were： （i） coronary artery spasm； （ii） diameter stenosis of the culprit lesion was ≤50% and coronary blood flow was normal； （iii） patients with severe left main coronary or multivessel disease， who had to require emergency revascularization. According to thrombolysis in myocardial infarction （TIMI）， the patients were divided into a reflow group and a no-reflow group. The clinical data， angiography findings and surgical data were compared between the two groups. Univariate and multivariate logistic regressions were used to determine the predictors for no-reflow. RESULTS： Fifty-four （17.3%） of the patients developed NR phenomenon after primary PCI. Univariate analysis showed that age， time from onset to reperfusion， systolic blood pressure （SBP） on admission， Killip class of myocardial infarction， intra-aortic balloon pump （IABP） use before primary PCI， TIMI flow grade before primary PCI， type of occlusion， thrombus burden on baseline angiography， target lesion len