Deutsches Herzzentrum, Technische Universität, Munich, Germany.
Circ Cardiovasc Interv. 2010 Feb 1;3(1):27-33. doi: 10.1161/CIRCINTERVENTIONS.109.896225. Epub 2010 Jan 26.
The investigation of no-reflow phenomenon after percutaneous coronary intervention (PCI) in patients with acute ST-segment-elevation myocardial infarction has therapeutic implications. We investigated the predictive factors, persistence in time, and impact of no reflow on myocardial salvage, ventricular function, and mortality.
The study included 1140 patients with ST-segment-elevation myocardial infarction undergoing primary PCI and paired scintigraphic examinations (before intervention and 7 to 14 days thereafter). After primary PCI, 108 patients had no reflow and 1032 patients had normal coronary flow. The median salvage index was 0.34 (interquartile range, 0.15, 0.49) in patients with no reflow versus 0.55 (interquartile range, 0.29, 0.81) in patients with normal flow (P<0.001). Left ventricular ejection fraction at 6 months after PCI was 47.7+/-13.1% in the no-reflow group versus 54.2+/-13.9% in the group with normal flow after PCI (P<0.001). In 80.3% of patients with no reflow, normalization of blood flow >6 months after PCI occurred and correlated with improvement in the left ventricular ejection fraction. Independent predictors of no reflow were residual flow in the infarct-related artery (P<0.001), initial perfusion defect (P=0.03), C-reactive protein (P<0.001), and previous myocardial infarction (P=0.013). Kaplan-Meier estimates of 1-year mortality were 16.7% (n=18) in patients with no reflow versus 5.5% (n=56) in patients with normal flow (hazard ratio, 3.35; 95% CI, 1.97 to 5.69; P<0.001).
No reflow after primary PCI was associated with reduced myocardial salvage, larger infarct size, worse left ventricular ejection fraction at 6 months, and increased risk of 1-year mortality. In 4 of 5 patients with no reflow after PCI, restoration of normal flow occurred 6 months after reperfusion.
经皮冠状动脉介入治疗（PCI）后无复流现象的研究具有治疗意义。我们研究了无复流的预测因素、持续时间以及对心肌挽救、心室功能和死亡率的影响。
这项研究纳入了 1140 例接受直接 PCI 治疗的 ST 段抬高型心肌梗死患者，并进行了配对闪烁扫描检查（治疗前和治疗后 7 至 14 天）。直接 PCI 后，108 例患者出现无复流，1032 例患者出现正常冠脉血流。无复流患者的中位心肌挽救指数为 0.34（四分位距，0.15，0.49），而正常血流患者为 0.55（四分位距，0.29，0.81）（P<0.001）。PCI 后 6 个月时左心室射血分数在无复流组为 47.7±13.1%，而在正常血流组为 54.2±13.9%（P<0.001）。在 80.3%的无复流患者中，>6 个月后血流恢复正常，与左心室射血分数的改善相关。无复流的独立预测因素是梗死相关动脉的残余血流（P<0.001）、初始灌注缺损（P=0.03）、C 反应蛋白（P<0.001）和既往心肌梗死（P=0.013）。无复流患者 1 年死亡率的 Kaplan-Meier 估计值为 16.7%（n=18），而正常血流患者为 5.5%（n=56）（风险比，3.35；95%CI，1.97 至 5.69；P<0.001）。
直接 PCI 后无复流与心肌挽救减少、梗死面积增大、6 个月时左心室射血分数更差和 1 年死亡率增加相关。在 18 例无复流患者中，有 4 例在再灌注后 6 个月恢复了正常血流。
