S Ding1,2, Y Shi3, X Sun2, Q Cao2, H Dai3, J Guan4. 1. Medical College, Qingdao University, Qingdao, China. 2. Department of Cardiology, Qingdao Eighth People's Hospital, Qingdao, China. 3. Department of Cardiology, Qingdao Municipal Hospital, No. 5, Donghai Middle Road, Shinan District, Qingdao, Shandong Province, China. 4. Department of Cardiology, Qingdao Municipal Hospital, No. 5, Donghai Middle Road, Shinan District, Qingdao, Shandong Province, China. guanjun3582@163.com.
Abstract
BACKGROUND: The angiographic slow/no-reflow phenomenon after primary percutaneous coronary intervention carries a poor prognosis for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). There is evidence that contrast agents cause endothelial dysfunction, myocardial cell damage, and coronary spasms. We hypothesized that the contrast agent dose may be related to slow/no-reflow in patients with NSTEACS undergoing percutaneous transluminal coronary angioplasty and stent (PTCA + stent). PATIENTS AND METHODS: We enrolled 3369 patients with NSTEACS who underwent PTCA + stent only in the culprit vessel for the first time from September 2007 to May 2017 in this study. Coronary blood flow of ≤TIMI grade 2 after PTCA + stent was defined as slow/no-reflow. The relationship between the contrast agent dose and slow/no-reflow phenomenon was analyzed by multivariate conditional logistic regression and smooth curve fitting. RESULTS: In multivariable conditional logistic regression analysis, the contrast agent dose was found to be an independent risk factor for slow/no-reflow after adjusting for the number of stents and the thrombus burden (OR: 1.0112; 95% CI: 1.0049-1.0176; p < 0.0001), and after adjusting for type 2 diabetes mellitus, NSTEACS risk stratification, application of platelet glycoprotein (GP) IIB/IIIA receptor antagonists, type of contrast agent, number of balloon dilatations, number of stents, and thrombus burden (OR: 1.0113; 95% CI: 1.0036-1.0191; p = 0.004). Further, the risk of slow/no-reflow increased significantly with the contrast agent level up to the inflection point of 160 ml. CONCLUSION: The contrast agent dose may be a risk factor for slow/no-reflow phenomenon after PTCA + stent in patients with NSTEACS. When the dose was greater than 160 ml, the risk of slow/no-reflow increased significantly.
BACKGROUND: The angiographic slow/no-reflow phenomenon after primary percutaneous coronary intervention carries a poor prognosis for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). There is evidence that contrast agents cause endothelial dysfunction, myocardial cell damage, and coronary spasms. We hypothesized that the contrast agent dose may be related to slow/no-reflow in patients with NSTEACS undergoing percutaneous transluminal coronary angioplasty and stent (PTCA + stent). PATIENTS AND METHODS: We enrolled 3369 patients with NSTEACS who underwent PTCA + stent only in the culprit vessel for the first time from September 2007 to May 2017 in this study. Coronary blood flow of ≤TIMI grade 2 after PTCA + stent was defined as slow/no-reflow. The relationship between the contrast agent dose and slow/no-reflow phenomenon was analyzed by multivariate conditional logistic regression and smooth curve fitting. RESULTS: In multivariable conditional logistic regression analysis, the contrast agent dose was found to be an independent risk factor for slow/no-reflow after adjusting for the number of stents and the thrombus burden (OR: 1.0112; 95% CI: 1.0049-1.0176; p < 0.0001), and after adjusting for type 2 diabetes mellitus, NSTEACS risk stratification, application of platelet glycoprotein (GP) IIB/IIIA receptor antagonists, type of contrast agent, number of balloon dilatations, number of stents, and thrombus burden (OR: 1.0113; 95% CI: 1.0036-1.0191; p = 0.004). Further, the risk of slow/no-reflow increased significantly with the contrast agent level up to the inflection point of 160 ml. CONCLUSION: The contrast agent dose may be a risk factor for slow/no-reflow phenomenon after PTCA + stent in patients with NSTEACS. When the dose was greater than 160 ml, the risk of slow/no-reflow increased significantly.
Authors: A S Abizaid; C E Clark; G S Mintz; S Dosa; J J Popma; A D Pichard; L F Satler; M Harvey; K M Kent; M B Leon Journal: Am J Cardiol Date: 1999-01-15 Impact factor: 2.778
Authors: Tadamichi Sakuma; Howard Leong-Poi; Nick G Fisher; Norman C Goodman; Sanjiv Kaul Journal: J Am Soc Echocardiogr Date: 2003-01 Impact factor: 5.251