CLINICAL STUDY
Predictive factors for development of the no-reflow phenomenon in patients with reperfused anterior wall acute myocardial infarction
Katsuomi Iwakura, MD*,
Hiroshi Ito, MD, FACC*,
Shigeo Kawano, MD*,
Yasunori Shintani, MD*,
Koichi Yamamoto, MD*,
Akinobu Kato, MD*,
Masashi Ikushima, MD*,
Koji Tanaka, MD*,
Masashi Kitakaze, MD ,
Masatsugu Hori, MD,
Yorihiko Higashino, MD* and
Kenshi Fujii, MD*
* Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
Department of Internal Medicine and Therapeutics, Graduate School of Medicine, Osaka University, Osaka, Japan
Manuscript received January 31, 2001;
revised manuscript received April 19, 2001,
accepted April 27, 2001.
Reprint requests and correspondence: Dr. Hiroshi Ito, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan
itomd{at}osk4.3web.ne.jp
OBJECTIVES
We sought to elucidate the clinical factors related to the development of no-reflow phenomenon after successful coronary reperfusion in patients with an acute myocardial infarction (AMI).
BACKGROUND
Myocardial contrast echocardiography revealed that the no-reflow phenomenon is observed in some patients with a reperfused AMI, and those patients usually have poor functional and clinical outcomes. It is still unknown what clinical factors are related to the development of the no-reflow phenomenon.
METHODS
Myocardial contrast echocardiography was performed 15 min after successful coronary reperfusion therapy in 199 patients with an anterior wall AMI who underwent successful coronary reperfusion with primary coronary angioplasty within 24 h after the onset of AMI. Multiple logistic regression analysis was used to identify independent predictors of the no-reflow phenomenon.
RESULTS
Seventy-nine patients showed the no-reflow phenomenon. Univariate analysis indicated that pre-infarction angina within 48 h before symptom onset, Killip class, Thrombolysis in Myocardial Infarction flow grade 0 on the initial coronary angiogram, the number of abnormal Q-waves and the wall motion score (WMS) on the echocardiogram obtained at hospital admission are related to the no-reflow phenomenon. Multivariate logistic regression analysis revealed that all of these factors, except for Killip class, are independent predictive factors of the no-reflow phenomenon.
CONCLUSIONS
Development of the no-reflow phenomenon is related to the severity of myocardial damage (number of Q-waves), the size of the risk area (WMS) and the occlusion status of infarct-related artery. In addition, ischemic preconditioning (pre-infarction angina) seems to be the factor that attenuates the no-reflow phenomenon.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | ATP | = adenosine triphosphate | | CK | = creatine kinase | | ECG | = electrocardiogram or electrocardiographic | | MCE | = myocardial contrast echocardiography | | PTCA | = percutaneous transluminal coronary angioplasty | | TIMI | = Thrombolysis In Myocardial Infarction | | WMS | = wall motion score |
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