Jinnouchi Hiroyuki, Sakakura Kenichi, Wada Hiroshi, Arao Kenshiro, Kubo Norifumi, Sugawara Yoshitaka, Funayama Hiroshi, Momomura Shin-ichi, Ako Junya
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Amanuma 1-847, Omiya, Saitama, 330-8503, Japan.
Heart Vessels. 2014 Jul;29(4):429-36. doi: 10.1007/s00380-013-0379-1. Epub 2013 Jun 27.
No reflow following primary percutaneous coronary intervention (PCI) is a serious complication in the treatment of acute myocardial infarction. No reflow in some patients is reversible (transient no reflow), whereas no reflow in others persists until the end of the procedure (persistent no reflow). The aim of this study was to identify clinical features of transient no reflow following primary PCI. Consecutive patients with no reflow (n = 123) were enrolled following primary PCI. Among them, 59 patients were in the transient group and 64 in the persistent group. We compared clinical features and hospital outcomes between the two groups. Multivariate logistic regression analysis was performed to identify the determinants of transient no reflow. The transient group had a lower rate of in-hospital cardiac death than the persistent group (0 vs. 6.4 %, relatively, P = 0.018). There was a trend for a shorter length of hospital stay in the transient group. Multivariate logistic regression analysis identified initial thrombolysis in myocardial infarction (TIMI) flow grade 3 (OR 6.239, 95 % CI 1.727-22.541, P = 0.005) and a higher estimated glomerular filtration rate (OR 1.204, 95 % CI 1.006-1.440, P = 0.042) as independent predictors of transient no reflow. Transient no reflow tended to be associated with TIMI thrombus grade ≤3 (OR 2.879, 95 % CI 0.928-8.931, P = 0.067). In conclusion, initial TIMI flow grade 3 and preserved renal function were associated with recovery from no reflow. Initial angiographic finding such as TIMI flow or TIMI thrombus grade might be an important predictor of recovery from the no-reflow phenomenon.
直接经皮冠状动脉介入治疗（PCI）后出现的无复流现象是急性心肌梗死治疗中的一种严重并发症。部分患者的无复流现象是可逆的（短暂性无复流），而其他患者的无复流现象会持续至手术结束（持续性无复流）。本研究的目的是确定直接PCI后短暂性无复流的临床特征。在直接PCI后，连续纳入了123例出现无复流现象的患者。其中，59例患者属于短暂性无复流组，64例属于持续性无复流组。我们比较了两组患者的临床特征和住院结局。进行多因素逻辑回归分析以确定短暂性无复流的决定因素。短暂性无复流组的院内心脏死亡率低于持续性无复流组（分别为0%和6.4%，P = 0.018）。短暂性无复流组的住院时间有缩短趋势。多因素逻辑回归分析确定，心肌梗死溶栓治疗（TIMI）血流分级3级（比值比[OR] 6.239，95%置信区间[CI] 1.727 - 22.541，P = 0.005）和较高的估计肾小球滤过率（OR 1.204，95% CI 1.006 - 1.440，P = 0.042）是短暂性无复流的独立预测因素。短暂性无复流倾向于与TIMI血栓分级≤3级相关（OR 2.879，95% CI 0.928 - 8.931，P = 0.067）。总之，初始TIMI血流分级3级和保留的肾功能与无复流现象的恢复相关。诸如TIMI血流或TIMI血栓分级等初始血管造影结果可能是无复流现象恢复的重要预测因素。
