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    Usefulness of transient and persistent no reflow to predict adverse clinical outcomes following percutaneous coronary intervention

    Access Status
    Fulltext not available
    Authors
    Chan, W.
    Stub, D.
    Clark, D.
    Ajani, A.
    Andrianopoulos, N.
    Brennan, A.
    New, G.
    Black, A.
    Shaw, J.
    Reid, Christopher
    Dart, A.
    Duffy, S.
    Date
    2012
    Type
    Journal Article
    
    Metadata
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    Citation
    Chan, W. and Stub, D. and Clark, D. and Ajani, A. and Andrianopoulos, N. and Brennan, A. and New, G. et al. 2012. Usefulness of transient and persistent no reflow to predict adverse clinical outcomes following percutaneous coronary intervention. American Journal of Cardiology. 109 (4): pp. 478-485.
    Source Title
    American Journal of Cardiology
    DOI
    10.1016/j.amjcard.2011.09.037
    ISSN
    0002-9149
    School
    Department of Health Policy and Management
    URI
    http://hdl.handle.net/20.500.11937/46477
    Collection
    • Curtin Research Publications
    Abstract

    The no reflow phenomenon is reported to occur in >2% of all percutaneous coronary interventions (PCIs) and portends a poor prognosis. We analyzed data from 5,286 consecutive patients who underwent PCI from the Melbourne Interventional Group (MIG) registry from April 2004 through January 2008 who had 30-day follow-up completed. Patients without no reflow (normal reflow, n = 5,031) were compared to 255 (4.8%) with no reflow (n = 217 for transient no reflow, n = 38 for persistent no reflow). Patients with transient or persistent no reflow were more likely to present with ST-elevation myocardial infarction (MI) or cardiogenic shock (p <0.0001 for the 2 comparisons). They were also more likely to have complex lesions (American College of Cardiology/American Heart Association type B2/C), have lesions within a bypass graft, require an intra-aortic balloon pump, receive glycoprotein IIb/IIIa inhibition, and have a longer mean stent length (p <0.0001 for all comparisons). In-hospital outcomes were significantly worse in those patients with transient or persistent no reflow, with increased death, periprocedural MI, renal impairment, and major adverse cardiac events (p <0.0001 for all comparisons). Similarly, transient and persistent no reflow portended worse 30-day clinical outcomes, with a progressive increase in mortality (normal reflow 1.7% vs transient no reflow 5.5% vs persistent no reflow 13.2%, p <0.0001), MI, target vessel revascularization, and major adverse cardiac events (p <0.0001 for all comparisons) compared to patients with normal flow. In conclusion, transient or persistent no reflow complicates approximately 1 in 20 PCIs and results in stepwise increases in in-hospital and 30-day adverse outcomes. © 2012 Elsevier Inc. All rights reserved.

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