Predictors of no- reflow during primary angioplasty for acute myocardial infarction, from Medical College Hospital, Trivandrum

Abstract

Background: Primary angioplasty (PCI) for acute myocardial infarction is associated with no-reflow phenomenon, in about 5-25% of cases. Here we analysed the factors predicting no reflow .

Methods: This was a case control study of consecutive patients with acute myocardial infarction who underwent Primary PCI from August 2014 to February 2015.

Results: Of 181 patients who underwent primary PCI, 47 (25.9%) showed an angiographic no-reflow phenomenon. The mean age was 59.19±10.25years and females were 11%. Univariate predictors of no reflow were age >60years (OR=6.146, 95%CI 2.937-12.86, P=0<0.001), reperfusion time >6h (OR=21.94, 95%CI 9.402-51.2, P=<0.001), low initial TIMI flow (≤1) (OR=12.12, 95%CI 4.117-35.65, P<0.001), low initial TMPG flow (≤1) (OR=36.19, 95%CI 4.847-270.2, P<0.001) a high thrombus burden (OR=11.04,95%CI 5.124-23.8, P<0.001), a long target lesion (OR=8.54, 95%CI 3.794-19.23, P<0.001), Killip Class III/IV(OR=2.937,95%CI 1.112-7.756,P=0.025) and overlap stenting(OR=3.733,95%CI 1.186-11.75,P=0.017). Multiple stepwise logistic regression analysis predictors were: longer reperfusion time>6h (OR=13.844, 95%CI 3.214-59.636, P=<0.001), age >60 years (OR=8.886, 95%CI 2.145-36.80, P=0.003), a long target lesion (OR=8.637, 95%CI 1.975-37.768, P=0.004), low initial TIMI flow (≤1) (OR=20.861, 95%CI 1.739-250.290, P=0.017).

Conclusions: It is important to minimize trauma to the vessel, avoid repetitive balloon dilatations use direct stenting and use the shortest stent if possible.

Keywords: No-reflow; Predictors; Primary angioplasty.