Predictors and Long‐term Prognosis of Angiographic Slow/No‐Reflow Phenomenon During Emergency Percutaneous Coronary Intervention for ST‐Elevated Acute Myocardial Infarction

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Abstract
Objective: Angiographic slow/no‐reflow during emergency percutaneous coronary intervention (PCI) in patients with ST‐elevated acute myocardial infarction (AMI) may result in unfavorable outcomes. The aim of our study was to investigate the clinical factors and angiographic findings that predict slow/no‐reflow phenomenon and the long‐term prognosis of AMI patients with angiographic slow/no‐reflow.Methods: A total of 210 consecutive AMI patients, who underwent primary PCI within 12 hours of symptom onset were divided into a normal flow group (thrombolysis in myocardial infarction [TIMI] flow grade 3, n = 169) and a slow/no‐reflow group (≤TIMI flow grade 2, n = 41), based on cineangiograms performed during PCI.Results: A total of 41 patients (19.5%) developed slow/no‐reflow phenomenon. Univariate analysis showed that delayed reperfusion, high thrombus burden on baseline angiography, and acute hyperglycemia all correlated with slow/no‐reflow (P < 0.05 for all). Multivariate analysis revealed that hyperglycemia on admission (≥10 mmol/L; odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.423–2.971, P = 0.012), reperfusion time (≥6 h; OR:1.4, 95% CI: 1.193–1.695, P = 0.040), and high thrombus burden (OR: 1.6, 95% CI: 1.026–2.825, P = 0.031) were significant and independent predictors of angiographic slow/no‐reflow. The 6‐month mortality and incidence of major adverse cardiac and cerebrovascular events (MACCE) were significantly higher in the slow/no‐reflow group than in the normal flow group. Angiographic slow/no‐reflow was independently predictive of MACCE (hazard ratio [HR]: 2.642, 95% CI: 1.304–5.932, P = 0.028).Conclusion: Delayed reperfusion, high thrombus burden on baseline angiography, and blood glucose level on admission can be used to stratify AMI patients into a lower or higher risk for angiographic slow/no‐reflow during PCI. In addition, angiographic slow/no‐reflow predicts an adverse outcome in AMI patients. Copyright

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