Clinical Research For No Reflow Phenomenon After Direct PCI With AMI

Background:Growing evidence suggests that no-reflow reperfusion after direct percutaneous coronary intervention (d-PCI) is associated with an unfavorable clinical outcome. Patients with AMI is the greastest risk factor for no-reflow phenomenon. But the relationship between other clinical factors and no-reflow phenomenon is still not clear. Sympathetic reflect of the heart which excitesα-adrenergic acceptor can induce microvascular spasm of the coronary artery system.α1-adrenergic blockade urapidil might be useful in preventing and treating no-reflow.Objective: We sought to investigate the predictive factors for development of the no-reflow phenomenon in patients with reperfused (after d-PCI ) acute myocardial infarction and the effects of intracoronary bolus of the selective a1-antagonist urapidil on myocardial perfusion after coronary stenting.Materials and methods:From October 2004 to March 2006, 131 patients who underwent successful coronary reperfusion with primary coronary angioplasty within 12 h after the onset of AMI were enrolled.Patients who were examined from October 2004 to October 2005 were divided into no-reflow group (n=21) and good-reflow group (n=62) according to the TIMI and blush grading ten minutes after stenting, The clinical significances such as preinfarction angina, Killip class, CK, result of ECG, UCG and CAG of patients were compared between the two groups. The prognosis 3 months after d-PCI was compared between no-reflow group and good-reflow group also.Patients from November 2005 to March 2006 were divided into urapidil group (n=24) and the control group (n=24). For the urapidil group 8mg urapidil were injected into the coronary artery. Ten minutes after stenting, coronary angiography was redone for comparison as to TIMI and blush grading. As for the control group, coronary angiography was repeated ten minutes later also for comparison as above.Results: The no-reflow group had a poorer prognosis compared to the good-reflow group. The patients were associated with poorer left ventricular (LV) function and higher mortality (19.1%vs8.06%, p＜0.05)。Between the two groups the sex,age,hypertension,smoking,diabetes h s C R P,width of Q R S,LVEF showed no significant differences. The tiptop pressure of the ballglobe and the diameter of the stent are also similar. But preinfarction angina, Killip class, CK peak value, BNP,cTnI and the time from symptom on set to reflow, the number of abnormal Q-waves, ST descent=50% after 2 hours showed significant differences. All patients of the no-reflow group had a total occlusion at IRA, while only 69.3 % of the good-reflow group had a total occlusion.The above clinical significances showing no significant differences for the urapidil group and the control group, but according to the blush grading ten minutes after stenting, the occur rate of the no-reflow phenomenon is lower in the urapidil group (16.67%vs29.2%,p＜0.05.)Conclusions: No-reflow indicates a poor prognosis. Preinfarction angina, Killip class, CK peak value, the time from symptom on set to reflow, the number of abnormal Q-waves, ST descent=50% after 2 hours is more frequently observed in patients with no-reflow. Low dose urapidil exhibited benefical effects on preventing no-reflow.