Predictores de fenómeno de no reflujo después de intervención coronaria percutánea primaria
Main Article Content
Keywords
Myocardial infarction, Primary percutaneous coronary intervention, No-reflow phenomenon, Predictor
Abstract
Background: No-reflow phenomenon is a common event in patients with acute myocardial infarction with ST elevation (STEMI) who underwent primary percutaneous coronary intervention. The objective is to determine the cumulative incidence of no-reflow phenomenon and some predictors related to its occurrence.
Methods: We retrospectively analyzed the reports of 71 patients with STEMI. Subjects were categorized in two groups, those with no-reflow phenomenon and those without it; their clinical findings were compared. Predictive factors were identified by logistic regression analysis.
Results: We identified 20 patients with no-reflow phenomenon (with a cumulative incidence of 28.1 %) and 51 with adequate reperfusion. In the univariate analysis the following predictors were related to the no-reflow phenomenon: CK-MB ≥ 160 UI/L, Killip class ≥ II, TIMI flow 0, having more than two Q waves in ECG, the form of reperfusion therapy and the presence of intracoronary thrombus. The multivariate logistic regression analysis identified Killip class ≥ II (OR = 9.3, p = 0.008), ≥ two Q waves in ECG (OR = 1.8, p = 0.05), angioplasty as unique reperfusion therapy (OR = 19.9, p = 0.017) and the presence of intracoronary thrombus (OR = 11.9, p = 0.008) as predictors of no-reflow phenomenon.
Conclusion: The early detection of predictors of no-reflow phenomenon will establish measures aimed to reduce its presentation.
References
Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med. 2007;357(11):1121-35.
ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Circulation. 2004; 110(5):588-636.
Férez Santander SM, Márquez MF, Peña Duque MA, Ocaranza Sánchez R, De la Peña Almaguer E, Eid Lidt G. Myocardial reperfusion injury. Rev Esp Cardiol. 2004;57(Suppl 1):9-21.
Rezkalla SH, Kloner RA. No-reflow phenomenon. Circulation. 2002;105(5):656-62.
Eeckhout E, Kern MJ. The coronary no-reflow phenomenon: a review of mechanisms and therapies. Eur Heart J. 2001;22(9):729-39.
Heidenreich PA, McClellan M. Trends in treatment and outcomes for acute myocardial infarction: 1975-1995. Am J Med. 2001;110(3):165-74.
Brosh D, Assali AR, Mager A, Porter A, Hasdai D, Teplitsky I, et al. Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. Am J Cardiol. 2007; 99(4):442-5. Epub 2006 Dec 20.
UpToDate [Internet]. Gibson CM, Carrozza JP, Laham RJ. Suboptimal reperfusion after primary percutaneous coronary intervention in acute ST elevation (Q wave) myocardial infarction. c2007. Disponible en
http://www.uptodate.com/contents/suboptimal-reperfusion -after-primary-percutaneous-coronary-intervention -in-acute-st-elevation-myocardial-infarction?source =search _result&search=Suboptimal+reperfusion+after+primary+percutaneous+coronary+intervention+in+acute+ST+elevation+%28Q+wave%29+myocardial+infarction&selectedTitle=2~150
Iwakura K, Ito H, Kawano S, Shintani Y, Yamamoto K, Kato A, et al. Predictive factors for development of the no-reflow phenomenon in patients with reperfused anterior wall acute myocardial infarction. J Am Coll Cardiol. 2001;38(2):472-7.
TIMI Study Group. The Thrombolysis in myocardial infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985;312(14):932-6.
Piana RN, Paik GY, Moscucci M, Cohen DJ, Gibson CM, Kugelmass AD, et al. Incidence and treatment of “no-reflow” after percutaneous coronary intervention. Circulation.1994;89(6):2514-8. doi: 10.1161/01.CIR.89.6.2514
Yip HK, Chen MC, Chang HW, Hang CL, Hsieh YK, Fang CY, et al. Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no- reflow phenomenon. Chest. 2002;122(4):1322-32. Texto libre en http://journal.publications.chestnet.org/article.aspx?articleid=1080979
Kirma C, Izgi A, Dundar C, Tanalp AC, Oduncu V, Aung SM, et al. Clinical and procedural predictors of no-reflow phenomenon after primary percutaneous coronary interventions: experience at a single center. Circ J. 2008;72(5):716-21. Texto libre en https://www.jstage.jst.go.jp/article/circj/72/5/72_5_716/_article
Tanaka A, Kawarabayashi T, Nishibori Y, Sano T, Nishida Y, Fukuda D, et al. No-reflow phenomenon and lesion morphology in patients with acute myocardial infarction. Circulation. 2002;105(18):2148-52.
Kloner RA, Ganote CE, Jennings RB. The “no-reflow” phenomenon after temporary coronary occlusion in the dog. J Clin Invest. 1974;54(6):1496-508.
Iwakura K, Ito H, Ikushima M, Kawano S, Okamura A, Asano K, et al. Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction. J Am Coll Cardiol. 2003;41(1):1-7.
Monteiro S, Gonçalves F, Monteiro P, Freitas M, Providência LA. The magnitude of the variation in glycemia: a new parameter for risk assessment in acute coronary syndrome? Rev Esp Cardiol. 2009;62(10):1099-108. Texto libre en http://www.revespcardiol.org/en/linkresolver/articulo-resolver /13142647/
Gasior M, Pres D, Stasik-Pres G, Lech P, Gierlotka M, Hawranek M, et al. Effect of blood glucose levels on prognosis in acute myocardial infarction in patients with and without diabetes, undergoing percutaneous coronary intervention. Cardiol J. 2008;15(5):422-30.
Shen XH, Jia SQ, Li HW. The influence of admission glucose on epicardial and microvascular flow after primary angioplasty. Chin Med J (Engl). 2006;119(2):95-102.
Olszowska M, Tracz W, Kostkiewicz M, Podolec P. Predictive factors of myocardial reperfusion in patients with anterior wall acute myocardial infarction. Cardiol J. 2008;15(1):57-62.
Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H, et al. 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. J Am Coll Cardiol. 2000;36(4):1202-9.
Hara M, Saikawa T, Tsunematsu Y, Sakata T, Yoshimatsu H. Predicting no-reflow based on angiographic features of lesions in patients with acute myocardial infarction. J Atheroscler Thromb. 2005;12(6):315-21. Texto libre en https://www.jstage.jst.go.jp/article/jat/12/6/12_6_315/_article
Watanabe T, Nanto S, Uematsu M, Ohara T, Morozumi T, Kotani J. et al. Prediction of no-reflow phenomenon after successful percutaneous coronary intervention in patients with acute myocardial infarction: intravascular ultrasound findings. Circ J. 2003; 67(8):667-71. Texto libre en https://www.jstage.jst.go.jp/article/circj/67/8/67_8_667/_article
Antoniucci D, Valenti R, Migliorini A, Moschi G, Bolognese L, Cerisano G, et al. Direct infarct artery stenting without predilation and no-reflow in patients with acute myocardial infarction. Am Heart J. 2001;142(4):684-90.