PMID- 12377860
OWN - NLM
STAT- MEDLINE
DCOM- 20021122
LR  - 20190514
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 122
IP  - 4
DP  - 2002 Oct
TI  - Angiographic morphologic features of infarct-related arteries and timely 
      reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow 
      phenomenon.
PG  - 1322-32
AB  - BACKGROUND: Growing evidence suggests that no-reflow reperfusion after direct 
      percutaneous coronary intervention (d-PCI) is associated with an unfavorable 
      clinical outcome. The purpose of this study was to evaluate whether 
      prerevascularization angiographic morphologic features of infarct-related 
      arteries (IRAs) and timely reperfusion could convey information on slow-flow 
      (Thrombolysis In Myocardial Infarction [TIMI] 2 flow) or no-reflow (TIMI grade < 
      or = 1 flow) reperfusion after d-PCI. METHODS AND RESULTS: Between May 1993 and 
      September 2000, d-PCI was performed in 794 consecutive patients with acute 
      myocardial infarction. Coronary blood flow failed to normalize in 120 patients 
      (15.1%). The incidence of failure to achieve TIMI 3 flow in the IRAs was 
      significantly higher in patients with vs those without the following distinctive 
      prerevascularization angiographic morphologic features: cutoff pattern of 
      occlusion in the IRA (52.4% vs 10.3%, p < 0.001), accumulated thrombus (> 5 mm) 
      proximal to the occlusion (37.5% vs 3.4%, p < 0.001), presence of floating 
      thrombus (66.7% vs 12.7%, p < 0.001), persistent dye stasis distal to the 
      obstruction (51.9% vs 13.8%, p < 0.001), reference lumen diameter (RLD) of the 
      IRA > or = 4 mm (46.3% vs 9.6%, p < 0.001), and incomplete obstruction with 
      presence of accumulated thrombus more than three times the RLD of the IRA (51.7% 
      vs 3.9, p < 0.0001). Each of these six angiographic morphologic features 
      indicated "high-burden thrombus formation." Multiple stepwise logistic regression 
      analysis demonstrated that each of six angiographic morphologic features was an 
      independent predictor of combined slow-flow and no-reflow phenomenon in the IRAs 
      after d-PCI (p < 0.05). In contrast, early reperfusion time (< 240 min, p = 
      0.0017), prerevascularization TIMI flow grade > or = 2 (p = 0.0006), and the 
      taper pattern of occlusion in the IRA (p = 0.0284) were independent predictors of 
      freedom from slow-flow or no-reflow phenomenon in the IRAs after d-PCI. The 
      30-day overall mortality was 8.7% (69 of 794 patients). The 30-day mortality was 
      significantly higher in patients with combined slow-flow and no-reflow phenomenon 
      than in patients with normal coronary blood flow after d-PCI (27.5% vs 5.3%, p < 
      0.001). CONCLUSIONS: Early reperfusion reduces the incidence of slow-flow or 
      no-reflow phenomenon in the IRA and overall 30-day mortality. The specific 
      angiographic morphologic features in the IRAs can be used as a simple and 
      efficacious method to predict slow-flow or no-reflow phenomenon. These findings 
      provide apparently clinically useful information for the selection of patients 
      who are potential candidates for subsequent prepercutaneous coronary intervention 
      adjunctive therapy.
FAU - Yip, Hon-Kan
AU  - Yip HK
AD  - Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial 
      Hospital, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 83301, Taiwan, ROC.
FAU - Chen, Mien-Cheng
AU  - Chen MC
FAU - Chang, Hsueh-Wen
AU  - Chang HW
FAU - Hang, Chi-Ling
AU  - Hang CL
FAU - Hsieh, Yuan-Kai
AU  - Hsieh YK
FAU - Fang, Chih-Yuan
AU  - Fang CY
FAU - Wu, Chiung-Jen
AU  - Wu CJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
SB  - IM
MH  - Adult
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/adverse effects/*methods/mortality
MH  - Coronary Angiography/*methods
MH  - Coronary Vessels/*pathology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Physiologic
MH  - Myocardial Infarction/*diagnostic imaging/mortality/*therapy
MH  - Postoperative Period
MH  - Predictive Value of Tests
MH  - Probability
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Statistics, Nonparametric
MH  - Survival Analysis
MH  - Thrombolytic Therapy/adverse effects/*methods/mortality
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Patency/*physiology
EDAT- 2002/10/16 04:00
MHDA- 2002/11/26 04:00
CRDT- 2002/10/16 04:00
PHST- 2002/10/16 04:00 [pubmed]
PHST- 2002/11/26 04:00 [medline]
PHST- 2002/10/16 04:00 [entrez]
AID - S0012-3692(15)37802-8 [pii]
AID - 10.1378/chest.122.4.1322 [doi]
PST - ppublish
SO  - Chest. 2002 Oct;122(4):1322-32. doi: 10.1378/chest.122.4.1322.