Cited by 475Acute Myocardial Infarction ResearchCoronary Interventions and DiagnosticsCardiac Ischemia and Reperfusion

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5-Year Prognostic Value of No-Reflow Phenomenon After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

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Ndrepepa, Gjin, Tiroch, Klaus, Fusaro, Massimiliano, Keta, Dritan, Seyfarth, Melchior, Byrne, Robert A., Pache, Jürgen, Alger, Patricia, Mehilli, Julinda, Schömig, Albert, Kastrati, Adnan·2010·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2009.12.054

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Abstract

Objectives The objective of this study was to investigate the impact of no-reflow phenomenon on 5-year mortality among patients with acute ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). This impact was also assessed in relation to infarct size.Background The impact of no-reflow on long-term mortality in patients with STEMI has been insufficiently studied.Methods This study included 1,406 patients with STEMI treated by primary PCI. No-reflow was diagnosed using angiographic criteria. Infarct size was measured with single-photon emission computed tomography imaging 7 to 14 days after the acute event. The primary outcome was 5-year mortality.Results The no-reflow phenomenon was diagnosed in 410 patients (29%). Infarct size was 15.0% (6.0% to 29.0%) of the left ventricle in the no-reflow group versus 8.0% (2.0% to 21.0%) of the left ventricle in the reflow group (p < 0.001). There were 132 deaths during follow-up. Of them, 59 deaths occurred among patients with no-reflow and 73 deaths occurred among patients with reflow (Kaplan-Meier estimates of 5-year mortality 18.2% and 9.5%, respectively; odds ratio: 2.02; 95% confidence interval: 1.44 to 2.82; p < 0.001). The Cox proportional hazards model adjusting for infarct size among other variables identified the no-reflow phenomenon as an independent correlate of 5-year mortality (hazard ratio: 1.66; 95% confidence interval: 1.17 to 2.36; p = 0.004).Conclusions In patients with STEMI treated by primary PCI, no-reflow phenomenon is a strong predictor of 5-year mortality. No-reflow phenomenon after PCI provides prognostic information that is independent of and beyond that provided by infarct size.

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Authors: Ndrepepa, G., Tiroch, K., Fusaro, M., Keta, D., Seyfarth, M., Byrne, R. A., Pache, J., Alger, P., Mehilli, J., Schömig, A., & Kastrati, A.
Affiliations: Deutsches Herzzentrum München (DE)
TUM Klinikum (DE)
Corresponding author: Ndrepepa, Gjin
ORCID: Ndrepepa, Gjin
Fusaro, Massimiliano
Seyfarth, Melchior
Byrne, Robert A.
Mehilli, Julinda
Kastrati, Adnan
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2010-05
Volume: 55
Issue: 21
Pages: 2383-2389
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2009.12.054
OpenAlex: W2096751472
Cited by: 475
References: 23
Citations by year: 2026: 22 · 2025: 23 · 2024: 31 · 2023: 37 · 2022: 27 · 2021: 38 · 2020: 32 · 2019: 45 · 2018: 28 · 2017: 21 · 2016: 31 · 2015: 33 · 2014: 36 · 2013: 27 · 2012: 15
FWCI: 15.15
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1172 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Ischemia and Reperfusion
Keywords: no-reflow phenomenon, ST-elevation myocardial infarction, primary percutaneous coronary intervention, long-term mortality, infarct size, prognostic factors, coronary microvascular dysfunction, single photon emission computed tomography
MeSH terms: Aged, Cause of Death, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction, Postoperative Care, Probability, Prognosis, Retrospective Studies, Severity of Illness Index, Time Factors, Cohort Studies, Tomography, Emission-Computed, Single-Photon, Angioplasty, Balloon, Coronary, Confidence Intervals, Proportional Hazards Models, Odds Ratio, Survival Analysis, Treatment Outcome, Coronary Angiography, Risk Assessment, Statistics, Nonparametric, Kaplan-Meier Estimate, No-Reflow Phenomenon

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5-Year Prognostic Value of No-Reflow Phenomenon After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

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