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5-Year Prognostic Value of No-Reflow Phenomenon After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction
Open accessAbstract
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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“Vasculature I/R injury alleviates the efficiency of reperfusion therapy and compromises the clinical benefits of patients with acute MI [181].”
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Metadata
- 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
- 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)
- 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
- 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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