No reflow associated with in-hospital and 30-day adverse events

10 February 2012

MedWire News: No reflow following percutaneous coronary intervention (PCI) is associated with an increased risk for adverse events in-hospital and within 30 days, research shows.

Patients with no reflow during or at the end of the PCI procedure had higher periprocedural complications, mortality, and major adverse cardiac events (MACE) than those who did not.

"These outcomes held true regardless if the no reflow was transient or persistent," report Stephen Duffy (Alfred Hospital, Melbourne, Australia) and colleagues in the American Journal of Cardiology.

Patients with persistent no reflow are known to have poor clinical outcomes, particularly if no reflow occurs in the setting of ST-segment elevation myocardial infarction (STEMI).

In a contemporary multicenter registry, Duffy and colleagues analyzed clinical outcomes in 5286 consecutive patients who underwent PCI between 2004 and 2008.

Normal reflow was observed in 5031 patients while 255 patients (4.8%) had no reflow. Of those with no reflow, 217 had transient and 38 persistent no reflow.

Patients with transient and persistent no reflow were more likely to undergo PCI for STEMI or be in cardiogenic shock when admitted.

In addition, these patients more often had complex lesions, had lesions within a bypass graft, required an intra-aortic balloon pump during PCI, and required glycoprotein IIb/IIIa inhibitors, and were treated with a longer stent.

Periprocedural and in-hospital MI, renal impairment, and in-hospital death rates were all significantly higher in patients with transient or persistent no reflow (p<0.001 for all comparisons) compared with those with normal reflow.

Overall, the group observed a step-wise increase in in-hospital adverse events in patients with normal reflow, transient no reflow and persistent no reflow.

At 30 days, all-cause and cardiac mortality, target lesion revascularization, target vessel revascularization, and MACE rates were higher in patients with transient and persistent no reflow.

"Improvements in adjunctive interventional pharmacology and devices are urgently needed to prevent the development of no reflow during PCI," state Duffy and colleagues.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

Am J Cardiol 2012; 109: 478-485