Prognosticating short-term outcomes in patients with STEMI-ACS and intra-procedural slow-flow/no-reflow phenomenon.

Abstract

Background: In this study, we compared the incidence of short-term outcomes between two groups of patients based on the occurrence of intra-procedural slow-flow/no-reflow phenomenon (SF/NR) and identified predictors of short-term outcomes. This study enrolled a consecutive series of patients diagnosed with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).

Methods: The patients were divided into two groups based on the presence or absence of SF/NR, and the incidence of short-term major adverse cardiovascular events (MACE) was compared between the two groups. Furthermore, the study aimed to identify predictors of short-term mortality in these patients. A total of 2582 patients were included, of whom 79.1% (n=2042) were male.

Results: The average age of the patients was 55.7 ± 11.2 years. Intra-procedural SF/NR was observed in 21.7% (560) of the patients. During median short-term follow-up of 180 days (144-205), patients with SF/NR exhibited a higher incidence of all-cause mortality (23.6% vs. 12.3%; p < 0.001) and MACE (30.4% vs. 16.9%; p < 0.001), with a hazard ratio of 1.82 (1.46-2.27; p < 0.001) and 1.69 (1.39-2.05; p < 0.001), respectively. Among patients with SF/NR, the following were found to be independent predictors of short-term mortality (adjusted odds ratios): total ischemic time, 1.04 (1.00-1.07; p = 0.041); random blood sugar levels, 1.01 (1.00-1.01; p < 0.001); intubation status, 2.79 (1.26-6.18; p = 0.011); post-procedural sub-optimal flow, 1.76 (1.04-2.98; p = 0.034); and intra-procedural arrhythmias, 5.48 (2.03-14.79; p < 0.001).

Conclusion: The presence of intra-procedural SF/NR has significant prognostic implications. Patients with intra-procedural SF/NR face a significantly higher risk of short-term adverse outcomes.