Τίτλος:
No-reflow phenomenon and comparison to the normal-flow population
postprimary percutaneous coronary intervention for ST elevation
myocardial infarction: case-control study (NORM PPCI)
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Introduction No-reflow (NR) phenomenon is characterised by the failure
of myocardial reperfusion despite the absence of mechanical coronary
obstruction. NR negatively affects patient outcomes, emphasising the
importance of prediction and management. The objective was to evaluate
the incidence and independent predictors of NR in patients presenting
with ST-elevation myocardial infarction (STEMI). Methods This was a
single-centre prospective case-control study. Cases were subjects who
suffered NR, and the control comparators were those who did not.
Clinical outcomes were documented. Salient variables relating to the
patients and their presentation, history and angiographical findings
were compared using one-way analysis of variance or chi(2)test. Multiple
regression determined the independent predictors, and a risk score was
established based on the beta coefficient. Results Of 173 consecutive
patients, 24 (13.9%) suffered from NR, with 46% occurring post stent
implantation. Patients with NR had increased risk of in-hospital death
(OR 7.0, 95% CI 1.3 to 36.7, p=0.022). From baseline variables
available prior to percutaneous coronary intervention, the independent
predictors of NR were increased lesion complexity, admission systolic
hypertension, weight of <78 kg and history of hypertension. Continuous
data were transformed into best-fit binary variables, and a risk score
was defined. Significant difference was demonstrated between the risk
score of patients with NR (4.1 +/- 1) compared with controls (2.6 +/- 1)
(p<0.001), and the risk score was considered a good test (area under the
curve=0.823). A score of >= 4 had 75% sensitivity and 76.5%
specificity. Conclusion Patients with NR have a higher rate of mortality
following STEMI. Predictors of NR include lesion complexity, systolic
hypertension and low weight. Further validation of this risk model is
required.
Συγγραφείς:
Rossington, Jennifer Ann
Sol, Eirini
Masoura, Konstantina and
Aznaouridis, Konstantinos
Chelliah, Raj
Cunnington, Michael and
Davison, Benjamin
John, Joseph
Oliver, Richard
Hoye, Angela
Εκδότης:
BMJ Publishing Group
Λέξεις-κλειδιά:
coronary intervention (PCI); acute coronary syndrome; interventional
cardiology
DOI:
10.1136/openhrt-2019-001215
