M Chettibi1, S Benghezel2, S Bertal2, R Nedjar2, M A Bouraghda2, M T C Bouafia2. 1. Service de cardiologie et de médecine interne, CHU Frantz-Fanon, Blida, Algérie; Université Saad Dahleb, Blida, Algérie. Electronic address: med.chettibi@yahoo.fr. 2. Service de cardiologie et de médecine interne, CHU Frantz-Fanon, Blida, Algérie; Université Saad Dahleb, Blida, Algérie.
Abstract
INTRODUCTION: During the past 20 years, significant progress has been made in the recanalization of ACS with ST elevation. It is now accepted that the reopening of the large coronary vessels in the acute phase of infarction by thrombolysis or angioplasty is necessary but not sufficient, because in 20-50% of cases, the coronary recanalization is an illusion of reperfusion. This phenomenon is called "no reflow". OBJECTIVE: The main objective of our study was to identify predictors of poor perfusion or "no reflow" in the acute phase of myocardial infarction. METHODS: Observational prospective study, in the department of cardiology and internal medicine, university hospital of Blida, over a period of 28 months from 1st September 2010 to 31st January 2013. We identified all patients hospitalized for myocardial infarction in acute phase, who underwent primary angioplasty or thrombolysis with angiographic control during a good TIMI flow. The endpoint was regression of ST segment (regression<50% ST-segment defined no reflow). RESULTS: Three hundred and seventy-nine patients were included. The mean age was 56.3±2.1, 87.8% of patients were male. In total, 35.9% hypertensive, 27.1% diabetic type 2, 50.1% and 10.8% dyslipidemia, smoking. One hundred and forty-seven (38.8%) developed a no reflow. Mortality was 3.9%, strongly correlated with no reflow (P=0.001). Predictors of no reflow after multivariate analysis were: age (OR 98, 0.961-0.996 95%, P=0.02), heart rate (1.01, 95% CI 0.998-1.02, P=0.035), the type 2 diabetes (odds ratio 1.87, CI 1.2-3.0, P=0.08), reaching the core (OR 7, 95% CI 1.2-18.4, P=0.027), direct stenting (OR 0.48, 95% CI 0.31-0.78, P=0.003). An interesting subgroup of patients was identified namely the subgroup strategy deferred primary angioplasty with stenting best reperfusion (OR 3.7, 95% CI 1.5-8.8, P=0.04), a lower rate of reocclusion of culprit artery and a lower rate of stenting with 23/51 (45.1%) versus 136/136 (100%) of immediate stenting group with a P<0.001. CONCLUSION: No reflow is a common phenomenon, strongly correlated with mortality predictors are age, heart rate, diabetes, achieving the core and direct stenting. The distal embolization in primary angioplasty is an important phenomenon, a delayed stenting strategy appears to limit this phenomenon.
INTRODUCTION: During the past 20 years, significant progress has been made in the recanalization of ACS with ST elevation. It is now accepted that the reopening of the large coronary vessels in the acute phase of infarction by thrombolysis or angioplasty is necessary but not sufficient, because in 20-50% of cases, the coronary recanalization is an illusion of reperfusion. This phenomenon is called "no reflow". OBJECTIVE: The main objective of our study was to identify predictors of poor perfusion or "no reflow" in the acute phase of myocardial infarction. METHODS: Observational prospective study, in the department of cardiology and internal medicine, university hospital of Blida, over a period of 28 months from 1st September 2010 to 31st January 2013. We identified all patients hospitalized for myocardial infarction in acute phase, who underwent primary angioplasty or thrombolysis with angiographic control during a good TIMI flow. The endpoint was regression of ST segment (regression<50% ST-segment defined no reflow). RESULTS: Three hundred and seventy-nine patients were included. The mean age was 56.3±2.1, 87.8% of patients were male. In total, 35.9% hypertensive, 27.1% diabetic type 2, 50.1% and 10.8% dyslipidemia, smoking. One hundred and forty-seven (38.8%) developed a no reflow. Mortality was 3.9%, strongly correlated with no reflow (P=0.001). Predictors of no reflow after multivariate analysis were: age (OR 98, 0.961-0.996 95%, P=0.02), heart rate (1.01, 95% CI 0.998-1.02, P=0.035), the type 2 diabetes (odds ratio 1.87, CI 1.2-3.0, P=0.08), reaching the core (OR 7, 95% CI 1.2-18.4, P=0.027), direct stenting (OR 0.48, 95% CI 0.31-0.78, P=0.003). An interesting subgroup of patients was identified namely the subgroup strategy deferred primary angioplasty with stenting best reperfusion (OR 3.7, 95% CI 1.5-8.8, P=0.04), a lower rate of reocclusion of culprit artery and a lower rate of stenting with 23/51 (45.1%) versus 136/136 (100%) of immediate stenting group with a P<0.001. CONCLUSION: No reflow is a common phenomenon, strongly correlated with mortality predictors are age, heart rate, diabetes, achieving the core and direct stenting. The distal embolization in primary angioplasty is an important phenomenon, a delayed stenting strategy appears to limit this phenomenon.