| Objective: This study was to investigate the clinical features, the main influencing factors and effect on heart function and short-term prognosis in no-reflow patients by contrasting and analyzing clinical manifestation, coronary angiographic change and operation effectiveness after d-PCI in patients with STEAMI. Materials and Methods: Cohort study method was used and 218 patients with primary STEAMI between January 2004 and December 2005 in our hospital (156 male, 62 female, average age 62.28±11.59 years) were involved in this study. All patients were submitted to d-PCI after admission and divided into two groups: reflow group and no-reflow group according to TIMI flow grade of the IRA. There are 182 patients in reflow group (male 134, female 48, average age 61.89±11.66 years) and 36 patients in no-reflow group (male 22, female 14, average age 64.28±11.13 years). Ventricular function and the main adverse cardiac events (MACE) were observed in hospital and during 6 months follow up in average. Correlation factors of no-reflow after d-PCI and the influence of no-reflow to heart function and prognosis were analyzed.Results: There was no significant difference between the two groups about age, sex, history of hypertension, diabetes, hypercholesterolemia, smoking and angina pectoris, angina pectoris before infarction, diastolic blood pressure when admission, heartrate ,and etc (every P>0.05). The incidence of no-reflow phenomenon was increased in patients with diabetes, but the difference was not significant (P>0.05);stress blood glucose when admission and the first fasting blood glucose after operation was significantly higher in no-reflow group than in reflow group (P<0.05). The incidence of no-reflow was significantly increased in patients with history of stroke (P<0.05), with anterior infarction/ extensive anterior infarction and combined with CRBBB (P<0.05). The incidence of no-reflow was higher in patients with Killip>IIgrade (P<0.05). The revascularization time of IRA was longer in no-reflow group than in reflow group (7.24±2.71 vs 5.40±2.47, PO.05). The difference in the incidence of no reflow among the three different reperfusion intervals (<4h, 4-6h and >6h) was significant (4.3% vs 18.6 vs 25.6%,P<0.05). TIMI risk score was higher in no-reflow group than in reflow group (P<0.05), the incidence of TSR>7 was higher in patients with no-reflow (31.3% vs 12.4%, P<0.05).The incidence of no-reflow phenomenon after PCI was increased in patients with total occlude lesion than patients with spontaneous recanalization (P<0.05);the ratio of total occlude lesion in the proximal of LAD was higher in no-reflow group (P<0.05);in addition, patients with high-burden thrombus formation in coronary angiography were more in no-reflow group than in reflow group (P<0.05);furthermore, the diameter of the balloons was lager and the length was longer in no-reflow group than in reflow group (P<0.05). Multiple logistic regression analysis demonstrated that history of stroke, combined with CRBBB, stress high blood glucose , anterior infarction, total occlude lesion, high-burden thrombus formation, revascularization time of IRA were the independent risk factors of no-reflow.There were significant differences in ECG index of SumSTR and MaxSTE between the two groups. The former was significantly lower in no-reflow group thanin reflow group (0.348±0.286 vs 0.560±0.290, P<0.05), whereas the percentage of MaxSTE high risk patients were higher (in no-reflow group) than in reflow group (63.9% vs 22.0%, P<0.05).The differences of left ventricular end-diastole diameter(LVEDD), left ventricular eject fraction (LVEF) and the ratio of segment movement between the two group were significant (every P<0.05) in 1 week after PCI. When compared with reflow group, LVEDD was lager, LVEF was lower, the ratio of segment movement was higher in no-reflow group. There were 2 patients in no-reflow group appeared paradoxical motion (6.9%), whereas there was no in reflow group. When compared in 1 month, there were also significant differences between the two groups (P<0.05). There was no more new paradoxical motion or ventricular aneurysm in no-reflow group, whereas there was 1 patient appeared paradoxical motion in reflow group. In both group the left ventricular contract function was greatly improved than before and LVEF was greatly increased in 1 month after PCI, however, there was no significant difference in amplification between the two groups (P>0.05).The incidence of MACE, mortality and the heart failure was higher in no-reflow group than in reflow group in hospital, and the differences between the two groups were significant (every P<0.05), moreover, patients in no-reflow group were more easily to develop malignant arrhythmia and stroke (both P>0.05). During 6 months' follow up, the accumulative total incidence of MACE, mortality and heart failure was significantly higher in no-reflow group than in reflow group (every P>0.05). Kaplan-Meier analysis demonstrated that 6 months' accumulative total survival rate curve without adverse cardiac events was higher in reflow group than in no-reflow group (P<0.001). The accumulative total survival rate without MACE in 7days and 30 days was respectively 27.8% and 19.4%. Main events usually developed within30 days after primary myocardial infarction, especially within 1 week after operation. There were 9 patients (25.0%) in no-reflow group submitted to platelet membrane glycoprotein II b/IIIa receptor blockers treatment, and in 1 month follow up LVEF was higher in the five discharge survival patients when compared with patients who didn't use it in no-reflow group, and the difference was significant (P<0.05).Conclusion: No-reflow phenomenon was significantly related to history of stroke, combined with CRBBB, stress high blood glucose, inferior infarction, total occlude lesion, high-burden thrombus formation and revascularization time of IRA;in patients with no-reflow the myocardial perfusion was poor and ST-segment resolution was incomplete;the heart function of patients with AMI was greatly influenced by no-reflow phenomenon after PCI;and there was higher incidence of MACE and higher mortality in patients with no-reflow in short-term. Platelet membrane glycoprotein II b/IIIa receptor blockers may improve the heart function of patients.
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