Long-term outcome and prognostic value of angiographic slow/no-reflow phenomenon after emergency percutaneous coronary intervention for ST-elevation myocardial infarction.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2024-08-01 Epub Date: 2024-04-02 DOI:10.1097/MCA.0000000000001362

Atefeh Bamarinejad, Mohammad Kermani-Alghoraishi, Azam Soleimani, Hamidreza Roohafza, Safoura Yazdekhasti, Amirhossein MirmohammadSadeghi, Fatemeh Bamarinejad, Masoumeh Sadeghi

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引用次数: 0

Abstract

Background: The coronary slow flow/no-reflow phenomenon (CSF/NRP) is a common complication of emergency percutaneous coronary intervention (PCI) for ST-elevated myocardial infarction (STEMI). Its long-term prognostic value, however, remains unclear. This study investigated the long-term outcome and prognostic value of CSF/NRP after emergency PCI for STEMI.

Methods: This retrospective, multicenter registry-based cohort study was conducted in STEMI patients who underwent emergency PCI between 2015 and 2016. Incidence of in-hospital mortality, major adverse cardiac and cerebrovascular events (MACCEs), and all-cause mortality during long-term follow-up were compared between CSF/NRP patients and the normal flow group. Cox proportional-hazards regression model was performed to identify the predictive impact of CSF/NRP in short- and long-term outcomes.

Results: A total of 649 STEMI patients were included in the study, of whom 193 (29.7%) developed CSF/NRP following emergency PCI. The CSF/NRP group had a higher incidence of in-hospital mortality than the non-CSF/NRP group (8.2 vs. 4.3%, P = 0.04). All-cause mortality incidence was also higher in the CSF/NRP group during 5-year follow-up (22.2 vs. 16.2%, P = 0.04). The Cox proportional hazards model adjusting for demographic and clinical variables identified the NRP as an independent predictor of 5-year cardiac mortality [hazard ratio: 1.89; 95% confidence interval (CI): 1.07-3.31; P = 0.02]. In a landmark analysis, no difference was seen in overall mortality among the two study groups between 1 month and 5-year follow-up (hazard ratio: 1.33; 95% CI: 0.80-2.21, P -value: 0.23). Kaplan-Meier analysis showed lower 3-year cumulative MACCE-free survival in the CSF/NRP group compared with the normal flow group ( P = 0.02).

Conclusion: CSF/NRP in STEMI patients is associated with a worse short- and long-term prognosis. These results, however, are mostly related to the acute phase, and CSF/NRP had limited influence on clinical outcomes in early survivors of STEMI.

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ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗后血管造影缓慢/无回流现象的长期疗效和预后价值。

背景：冠状动脉血流缓慢/无回流现象（CSF/NRP）是ST段抬高型心肌梗死（STEMI）急诊经皮冠状动脉介入治疗（PCI）的常见并发症。然而，其长期预后价值仍不明确。本研究调查了 STEMI 急诊 PCI 后 CSF/NRP 的长期结果和预后价值：这项基于多中心登记的回顾性队列研究针对 2015 年至 2016 年间接受急诊 PCI 的 STEMI 患者。比较了CSF/NRP患者和正常血流组在长期随访期间的院内死亡率、主要不良心脑血管事件（MACCE）和全因死亡率。采用 Cox 比例危险回归模型确定 CSF/NRP 对短期和长期预后的预测影响：研究共纳入649例STEMI患者，其中193例（29.7%）在急诊PCI术后出现CSF/NRP。CSF/NRP组的院内死亡率高于非CSF/NRP组（8.2%对4.3%，P=0.04）。在5年随访期间，CSF/NRP组的全因死亡率也更高（22.2% 对 16.2%，P = 0.04）。根据人口统计学和临床变量调整的 Cox 比例危险模型确定，NRP 是 5 年心脏死亡率的独立预测因子[危险比：1.89；95% 置信区间 (CI)：1.07-3.31；P = 0.02]。在一项标志性分析中，两个研究组在 1 个月至 5 年随访期间的总死亡率没有差异（危险比：1.33；95% CI：0.80-2.21；P 值：0.23）。Kaplan-Meier分析显示，与正常血流组相比，CSF/NRP组的3年累积无MACCE生存率较低（P = 0.02）：结论：STEMI 患者的 CSF/NRP 与较差的短期和长期预后有关。结论：STEMI 患者的 CSF/NRP 与较差的短期和长期预后有关，但这些结果主要与急性期有关，CSF/NRP 对 STEMI 早期幸存者的临床预后影响有限。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.