NCDR Study Shows No-Reflow During PCI Results in Higher Mortality, Adverse Outcomes

A study published on Jan. 30 in the American Journal of Cardiology found that patients who developed the no-reflow phenomenon during percutaneous coronary intervention (PCI) had higher rates of major adverse clinical outcomes, including in-hospital mortality, reinfarction, cardiogenic shock and heart failure (HF) compared with those who did not develop no-reflow, although the incidence of no-reflow was found to be low.

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The study analyzed the records of 291,380 patients with acute myocardial infarction (AMI) in the NCDR's CathPCI Registry® who underwent PCI of native coronary stenoses for ST-segment elevation myocardial infarction (STEMI) and non-STEMI from 2004 to 2008. Results showed that no-reflow developed in 2.3 percent (6,553) of the AMI patients during PCI, resulting in in-hospital mortality that was more than threefold greater in these patients than in patients who did not develop no-reflow (13 vs. 4 percent, respectively; p<0.0001). The patients who developed no-reflow were more likely to die on the day of the PCI (4.5 vs. 0.8 percent; p<0.0001) and more likely to die in the catheterization lab (25 vs. 11 percent; p<0.0001).

Also greater in the no-reflow patients was the rate of reinfarction (2.4 vs. 0.7 percent), new-onset cardiogenic shock (7.4 vs. 1.7 percent) and HF (5.2 percent vs. 2.1 percent). In addition, the infarct size was larger among the no-flow patients (median 133 vs. 76 ng/ml; p<0.0001).

"To date, the present report is the largest study of the no-reflow phenomenon among patients with AMI undergoing PCI," the authors note. They conclude that "the development of no-reflow, although relatively uncommon during PCI for AMI, is associated with adverse clinical outcomes. Upfront strategies to reduce the incidence of no-reflow could be considered for high-risk patients to improve outcomes."

Keywords: Shock, Cardiogenic, Registries, Myocardial Infarction, Hospital Mortality, Coronary Stenosis, Heart Failure, Catheterization, United States, Percutaneous Coronary Intervention

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