| Objective: This study was to investigate the clinical features and coronary artery character of no-reflow phenomenon post-PCI in patients with AMI and its influence on heart function and prognosis.Methods: 137 patients (109 male, 28 female, average age 56.79±12.10years) were involed in this study. Exclusion criterion were the history of old myocardial infarction, chronic heart failure, dissection during PCI, left main trunk lesion,valvulaar heart disease, cardiomyopathy. All patients were submitted to coronary angiography (CAG), percutaneous coronary intervention (PCI) and left ventriculography (LVG) 2 to 72 hours after admission and divided into two groups:no reflow group and reflow group according to the result of CAG post PCI. Left ventricular end diastolic pressure (LVEDP) was recorded. Equilibrium radionuclide angiography (ERNA) were performed in 5 to 8 days after the onset of AMI to evaluate the heart function.Results: There was no significant difference between the two groups about the age, sex, interval time from onset to PCI procedure, history of smoking, drinking , hypertension and diabetes, rate of muti-vessel lesion. Patients with pre-Angina pectoris have lower incidence of no reflow compared with those without angina pectoris (12.96% VS 27.71%, P<0.05). The coronary lesion of patient with no reflow is mainly lying in occluded/suboccluded proximal or midst section of left anterior descending artery (LAD) (56.67%). Anterior wall myocardial infarction and total occlusion lesion increase the incidence of no reflow (27.54% vs 16.18%, 26.47% vs 17.39%, P>0.05); Diabetes and collateral circulation have lower incidence of no reflow (11.11% vs 24.55%, 14.93% vs 28.57%, p>0.05). There are higher incidence of no reflow in patient withKillip≥2 grade(39.29% vs 17.43%,P<0.05). Patients treated with direct stenting have lower incidence of no reflow (11.63% vs 26.60%,P<0.05). Among no reflow group, systolic and diastolic heart function are both injured( LVEF 45.86±17.99 vs 59.98±12.62,P<0.01; PER 2.86±1.04 vs 3.92±1.08, P<0.01; TPER 138±20 vs 123±28, P<0.01; PFR 2.02±0.78 vs 2.97±0.74, P<0.05; TPFR 229±64 vs 169±58, P<0.01),The patients with no reflow have worse VSS compared with patients without no reflow . PSD, PS and FWHM of no reflow were increased (18.12±8.57 vs 12.11±5.16,66.07±15.43оvs 47.32±15.20о, 25.38±9.61оvs 19.62±5.16о, P<0.05,respectively). LVEDP and CK peak value is higher in no reflow group than in reflow group(24.24±10.05 vs 19.41±7.55,P<0.05, 4283±3098 vs 2285±1586 , P<0.0001). The incidence of ventricular aneurysm, complication and mortality also increased in no reflow group (60.00% vs 42.05%, P<0.05; 36.67% vs 14.02%, P<0.05; 16.67% vs 3.73%, P<0.05, respectively). According to Logistic muti-variable regression analysis, proximal LAD occlusion, the numbers of pathological Q waves leads, CK peak value, lack of angina before AMI are the independent risk factors of no reflow.Conclusion: No reflow phenomenon after PCI in patients with AMI affect systolic and diastolic heart function and prognosis. According to Logistic muti-variable regression analysis, proximal LAD occlusion, the numbers of pathological Q waves leads, CK peak value, lack of angina before AMI are the independent risk factors to no reflow phenomenon...
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