CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction
Itsuro Morishima, MD*,
Takahito Sone, MD ,
Kenji Okumura, MD*,
Hideyuki Tsuboi, MD,
Junichiro Kondo, MD,
Hiroaki Mukawa, MD,
Hideo Matsui, MD*,
Yukio Toki, MD*,
Takayuki Ito, MD and
Tetsuo Hayakawa, MD, PhD*
* Department of Internal Medicine II, Nagoya University School of Medicine, Nagoya, Japan
Health Sciences, Nagoya University School of Medicine, Nagoya, Japan
Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
Manuscript received May 6, 1999;
revised manuscript received March 27, 2000,
accepted June 1, 2000.
Reprint requests and correspondence: Itsuro Morishima, Internal Medicine II, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
itsuro{at}med.nagoya-u.ac.jp
OBJECTIVES
We sought to elucidate the long-term prognostic importance of angiographic no-reflow phenomenon after percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI).
BACKGROUND
Angiographic no-reflow phenomenon, a reduced coronary antegrade flow (Thrombolysis in Myocardial Infarction [TIMI] flow grade  2) without mechanical obstruction after recanalization, predicts poor left ventricular (LV) functional recovery and survival in the early phase of AMI. We hypothesized that angiographic no-reflow phenomenon also predicts long-term clinical outcome.
METHODS
We studied 120 consecutive patients with their first AMI treated by PTCA without flow-restricting lesions. The patients were classified as either no-reflow (n = 30) or reflow (TIMI-3) (n = 90) based on post-PTCA cineangiograms to follow up (5.8 ± 1.2 years) for cardiac death and nonfatal events.
RESULTS
Patients with no-reflow had congestive heart failure (p < 0.0001), malignant arrhythmia (p = 0.038), and cardiac death (p = 0.002) more often than did those with reflow. Kaplan-Meier curves showed lower cardiac survival and cardiac event-free survival (p < 0.0001) in patients with no-reflow than in those with reflow. Multivariate analyses disclosed that no-reflow phenomenon was an independent predictor of long-term cardiac death (relative risk [RR] 5.25, 95% confidence interval [CI] 1.85 to 14.9, p = 0.002) and cardiac events (RR 3.71, 95% CI 1.79 to 7.69, p = 0.0004). At follow-up, survivors with no-reflow had higher end-diastolic and end-systolic LV volume indices and plasma brain natriuretic peptide levels, and lower LV ejection fractions (p = 0.0002, p < 0.0001, p = 0.002, p < 0.0001, respectively) than did those with reflow, indicating that no-reflow may be involved in LV remodeling.
CONCLUSIONS
Angiographic no-reflow phenomenon strongly predicts long-term cardiac complications after AMI; these complications are possibly associated with LV remodeling.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | BNP | = brain natriuretic peptide | | CHF | = congestive heart failure | | CK | = creatine kinase | | IRA | = infarct-related artery | | LV | = left ventricular | | LVEDVI | = left ventricular end-diastolic volume index | | LVEF | = left ventricular ejection fraction | | LVESVI | = left ventricular end-systolic volume index | | MI | = myocardial infarction | | NYHA | = New York Heart Association | | PTCA | = percutaneous transluminal coronary angioplasty | | TIMI | = Thrombolysis in Myocardial Infarction trial |
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