Clinical and Angiographic Predictive Factor for the Development of No-reflow/Slow flow Phenomenon during Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

BACKGROUND: No-reflow/slow flow phenomenon in acute myocardial infarction(AMI) patients is associated with poor clinical and functional outcomes. The use of distal protective device during primary percutaneous coronary intervention(PCI) for AMI reduce no-reflow/slow flow phenomenon in some patients, but not all cases. The identification of high risk group for development of no-reflow/slow flow phenomenon is important. We assessed the clinical and angiographic predictive factor for development of no-reflow/slow flow phenomenon after primary PCI in AMI patients. METHODS: Total 122 patients were performed primary PCI for AMI within 12hours of the onset of symptom. We divided patient into two groups - no reflow/slow flow group(TIMI 0,1,2) vs reflow(TIMI 3) group- compared clinical(risk factor, reperfusion time, Killip classifiction), laboratory(cardiac enzyme, WBC, hsCRP), echocardiographic(EF, WMSI), angiographic and procedural parameter including the balloon times at infarct-related artery during primary PCI. RESULTS: The incidence of no-reflow/slow flow phenomenon was 31%(38 patients). There were no difference in risk factor, preintervention diameter stenosis, minimal luminal diameter and reference vessel size between two groups. Cardiac enzyme(CK, CK-MB, troponin-T) at admission and wall motion score index(WMSI) were higher in no-reflow/slow flow group. Ejection fraction(EF) was lower in no- reflow group. Reperfusion time after 6 hours (65.8% vs 26.2%, p<0.001), more frequent predilatation(≥3 times) at infarct-related artery (21.1% vs 8.3%, p=0.048), lesion length ≥ 20mm (71.1% vs 33.7%, p<0.001), troponin-T ≥ 0.25ng/ml (57.9% vs 22.6%, p<0.001) and wall motion score index more than 1.3 (77.8% vs 50%, p=0.005) were more common at no-reflow/slow flow group. Multivariate logistic regression analysis revealed that reperfusion time after 6 hours(odd ratio 4.74, p=0.002), lesion length ≥ 20mm(odd ratio 4.17, p=0.007) and troponin-T ≥ 0.25ng/ml(odd ratio 4.54, p=0.003) were independent predictive factor for development of no-reflow/slow flow phenomenon. CONCLUSION: Development of no-reflow/slow flow phenomenon during primary PCI in AMI patients is associated with the duration of occlusion(reperfusion time), troponin-T level and length of lesion. The identification of high risk patient for development of no-reflow/slow flow phenomenon and appropriate use of other therapeutic approach such as distal protective device are seemed to be beneficial during primary PCI in AMI patients.

Author dc:creator

• 양, 형모

Contributors dc:contributor

• 탁, 승제
• 대학원 의학과
• 103247

• No-reflow/slow flow 현상
• 심근경색증
• No-reflow/slow flow phenomenon
• Myocardial infarction

Language dc:language

ko

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000005780
000000005780

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/1829