Relative Factors For Angiographic No Reflow Phenomenon After Primary Percutaneous Coronary Intervention In Patients With Acute Myocardial Infarction

Objective Directed PCI is an efective treatment of AMI and widely used in our country.But,no-reflow phenomenon after coronary artery recanalization makes it impossible to provide enough blood flow to sever ischemic or nearly to necrosismyocardium. This study aims to elucidate the relative factors and prognostic impact for angiogrphic no reflow phenomenon after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods There were 242 patients with acute myocardial infarction in the re-seach.All cases were examined by coronary artery angiograghy before and after primary percutaneous coronary intervention therapy.Twenty eight patients were with angiogrphic no reflow phenomenon which are defined as coronary antergrade flow below TIMI 3 class after primary PCI ,and 214 patients were regarded as normal flow group with coronary antergrade flow TIMI 3 class.Two groups were investigated and contrasted by the following items: age,sex,smoking,hypertension, hyperlipemia,diabetes mellitus,CK-MB value on admission, compensatory circulation, initial TIMI flow grade 0 ,the time from symptom onset to reflow, IRA, the preinfaction angina, Killip class>2,the number of Q waves on electrocardiogam, thrombus in coronary artery, medication before AMI.MACE was compared between the two groups. Multiple logistic regression analysis was used to identify independent relative factors of the no reflow phenomenon.Results Incidence of the no reflow phenomenon was 11.6% in all 242 patients.There was no diference in terms ofage,sex,smoking,hypertension,hyperlipemia,diabetes mellitus,CK-MB value on admission,IRA, compensatory circulation, thrombus in coronary artery .Multiple logistic regression analysis indicated that initial TIMI flow grade 0 , the time from symptom onset to reflow , the preinfaction agina, Killip class>2,the number of Q waves on electrocardiogam , chronic pretreatment of ACEI, chronic pretreatment of statins were the relative factors of the no-reflow phenomenon. In-hospital MACE were significantly higher in no-flow patients than normal flow patients.Conclusions Initial TIMI flow grade 0 ,the time from symptom onset to reflow, Killip class>2,the number of Q waves on electrocardiogam, anterior wall infarction were the relative risk factors of the no reflow phenomenon.They illustrate that large area of myocardial necrosis,the severely myocardial damage, heart failure and the long time from the symptom onset to reflow can promote the angiogrphic no reflow phenomenon. Preinfaction angina, chronic pretreatment of ACEI, chronic pretreatment of statins seem to be the safety factors that atenuate the angiogrphic no reflow phenomenon. No-reflow phenomenon indicates a poor in- hospital prognosis.