Influence of the phenomenon of no-reflow after percutaneous coronary intervention on long-term prognosis in patients with ST elevation acute myocardial infarction (results of a prospective study)

Abstract

The aim – to determine the impact of the «no-reflow» phenomenon (NRP) after percutaneous coronary intervention (PCI) upon long-term prognosis in patients with ST elevation myocardial infarction (STEMI) and the effect of NRP on the incidence of complications of acute myocardial infarction during the acute period.
Material and methods. 105 patients with STEMI aged 36 to 85 years were studied, the mean age was 60.40±2.03 years. PCI was performed immediately after the diagnosis of STEMI, an average of 7.6±1.2 hours after the onset of the first symptoms. No-reflow was determined after the recanalization of the infarct-related artery (IRA) as the absence of optimal myocardial perfusion using the MBG (Myocardial blush grade, MBG ≤ 2) scale. Patients in whom NRP was fixed were assigned to the main group, n=18 (17.1 %), patients whose angiographic data met the criteria for successful PCI were appropriately allocated to the control group, n=87 (82.9 %). The final combined point was nonfatal repeated myocardial infarction, nonfatal stroke, cardiovascular death (CVD), and repeated hospitalization for the recurrence of the angina pectoris within one year after intervention.
Results. In the main group, postinfarction angina (OR 3.79, 95 % CI 1.08–13.42, Р<0.05), acute left and/or right ventricular failure was significantly more frequent (OR 7.98; 95 % CI 1.89–33.65, Р<0.05) and there were more cases of ventricular fibrillation (OR 12.14, 95 % CI 2.03–72.67, Р<0.05). At the end of 10.9±1.6 months it was found that the incidence of the combined endpoint in the patients of the main group is significantly higher than in the control group (OR 3.89, 95 % CI 1.36–11.24, Р<0.05). The greatest contribution to the difference between the groups at the combined endpoint was made by the discrepancy between the study groups for CVD (OR 10.38, 95 % CI 2.55–42.18, Р<0.05)
Conclusions. NRP in patients STEMI after PCI is related to the development of postinfarction angina, acute left
and/or right ventricular failure, ventricular fibrillation. The strongest link was established between the development of NRP and cardiovascular mortality during the first 30 days in patients after intervention. It was not possible to establish connection between NRP and re-hospitalization for the resumption of angina pectoris, the incidence of non-fatal recurrent myocardial infarctions and non-fatal strokes.