Background: No-reflow occurring during percutaneus coronary intervention (PCI) has been associated with poor in-hospital outcomes. Purpose: The objectives of this study were to evaluate the incidence of no-reflow as independent predictor of adverse events and to assess whether baseline preprocedural treatment options may affect clinical outcomes. Methods: Data were derived from the International Survey of Acute Coronary Syndromes in Transitional Countries (NCT01218776) registry, a prospective survey of patients presenting with ACS over a 5-year period (January 2010 to January 2015). We prospectively collected data from 5997 patients undergoing PCI, identifying those with no-reflow, and analyzed their treatments and clinical outcomes. No-reflow was defined as post-PCI TIMI flow grade 0–1, in the absence of post-procedural significant (≥25%) residual stenosis, abrupt vessel closure, dissection, perforation, thrombus of the original target lesion, or epicardial spasm. The outcome measure was in-hospital mortality. Results: No-reflow was identified in 128 of 5997 patients who have undergone PCI (2.1%). On multivariate analysis, patients with no-reflow were more likely to be older (≥75 years; OR: 2.78; 95% CI: 1.15–6.71) and to have ST-elevation myocardial infarction (OR: 3.67; 95% CI: 1.57–8.56). No-reflow was highly predictive of in-hospital mortality (17.2% vs. 4.2%, P<0.001) and remained a significant independent predictor of death after adjustment for demographic and clinical variables (OR: 4.78; 95% CI: 2.7- 8.3). Multivariable regression analysis was also performed to identify independent relationship between pre-procedural treatment regimens and no-reflow phenomenon. A 600 mg loading dose of clopidogrel, showed a strong inverse predictive value in terms of post-PCI TIMI flow and no-reflow phenomenon (OR: 0.58; 95% CI: 0.35–0.95). Similarly, unfractioned heparin was associated with a reduction in the likehood of no-reflow (OR: 0.62; 95% CI: 0.41–0.94). Aspirin, enoxaparin, 300 mg loading dose of clopidogrel, did not significantly impact the occurrence of the no-reflow. Conclusions: No-reflow is a strong independent predictor of in-hospital mortality. Pre-procedural administration of 600 mg loading dose of clopidogrel and/or unfractioned heparin is associated with reduced incidence of no-reflow
Effect of pre-procedural antiplatelet and anticoagulant therapy on myocardial no-reflow following percutaneus coronary intervention
CENKO, EDINA;RICCI, BEATRICE;MANFRINI, OLIVIA;BUGIARDINI, RAFFAELE
2015
Abstract
Background: No-reflow occurring during percutaneus coronary intervention (PCI) has been associated with poor in-hospital outcomes. Purpose: The objectives of this study were to evaluate the incidence of no-reflow as independent predictor of adverse events and to assess whether baseline preprocedural treatment options may affect clinical outcomes. Methods: Data were derived from the International Survey of Acute Coronary Syndromes in Transitional Countries (NCT01218776) registry, a prospective survey of patients presenting with ACS over a 5-year period (January 2010 to January 2015). We prospectively collected data from 5997 patients undergoing PCI, identifying those with no-reflow, and analyzed their treatments and clinical outcomes. No-reflow was defined as post-PCI TIMI flow grade 0–1, in the absence of post-procedural significant (≥25%) residual stenosis, abrupt vessel closure, dissection, perforation, thrombus of the original target lesion, or epicardial spasm. The outcome measure was in-hospital mortality. Results: No-reflow was identified in 128 of 5997 patients who have undergone PCI (2.1%). On multivariate analysis, patients with no-reflow were more likely to be older (≥75 years; OR: 2.78; 95% CI: 1.15–6.71) and to have ST-elevation myocardial infarction (OR: 3.67; 95% CI: 1.57–8.56). No-reflow was highly predictive of in-hospital mortality (17.2% vs. 4.2%, P<0.001) and remained a significant independent predictor of death after adjustment for demographic and clinical variables (OR: 4.78; 95% CI: 2.7- 8.3). Multivariable regression analysis was also performed to identify independent relationship between pre-procedural treatment regimens and no-reflow phenomenon. A 600 mg loading dose of clopidogrel, showed a strong inverse predictive value in terms of post-PCI TIMI flow and no-reflow phenomenon (OR: 0.58; 95% CI: 0.35–0.95). Similarly, unfractioned heparin was associated with a reduction in the likehood of no-reflow (OR: 0.62; 95% CI: 0.41–0.94). Aspirin, enoxaparin, 300 mg loading dose of clopidogrel, did not significantly impact the occurrence of the no-reflow. Conclusions: No-reflow is a strong independent predictor of in-hospital mortality. Pre-procedural administration of 600 mg loading dose of clopidogrel and/or unfractioned heparin is associated with reduced incidence of no-reflowI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.