The no-reflow phenomenon in the young and in the elderly
Por:
Cenko, E, Ricci, B, Kedev, S, Kalpak, O, Calmac, L, Vasiljevic, Z, Knezevic, B, Dilic, M, Milicic, D, Manfrini, O, Koller, A, Dorobantu, M, Badimon, L, Bugiardini, R
Publicada:
1 nov 2016
Resumen:
Background: The objectives of this study were to evaluate the incidence of no-reflow as independent predictor of adverse events and to assess whether baseline pre-procedural treatment options may affect clinical outcomes.
Methods: Data were derived from the ISACS-TC registry (NCT01218776) from October 2010 to January 2015. No-reflow was defined as post-PCI TIMI flow grades 0-1, in the absence of post-procedural significant (>= 25%) residual stenosis, abrupt vessel closure, dissection, perforation, thrombus of the original target lesion, or epicardial spasm. The outcome measure was in-hospital mortality.
Results: No-reflow was identified in 128 of 5997 patients who have undergone PCI (2.1%). On multivariate analysis, patients with no-reflow were more likely to be older (OR: 1.20, 95% CI: 1.01-1.44), to have a history of hypercho-lesterolemia (OR: 1.95, 95% CI: 1.31-2.91) and to be admitted with a diagnosis of STEMI (OR: 2.96, 95% CI: 1.85-4.72). Angiographic characteristics associated with no-reflow phenomenon were: stenosis >= 50% of the right coronary artery, presence of multivessel disease and pre-procedural TIMI blood flow grades 0-1. No-reflow was highly predictive of in-hospital mortality (17.2% vs. 4.2%; adjusted OR: 4.60, 95% CI: 2.61-8.09). Administration of pre-procedural unfractioned heparin or 600 mg clopidogrel loading dose was associated with less incidence of no-reflow (OR: 0.65, 95% CI: 0.43-0.99 and 0.61, 95% CI: 0.37-1.00, respectively). Aspirin, enoxaparin, and 300 mg clopidogrel loading dose, did not significantly impact the occurrence of the no-reflow.
Conclusions: We found that pre-procedural administration of 600 mg loading dose of clopidogrel and/or unfractioned heparin is associated with reduced incidence of no-reflow. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
Filiaciones:
Cenko, E:
Univ Bologna, Dept Expt Diagnost & Specialty Med, I-40126 Bologna, Italy
Ricci, B:
Univ Bologna, Dept Expt Diagnost & Specialty Med, I-40126 Bologna, Italy
Kedev, S:
Univ St Cyril & Methodius, Univ Clin Cardiol, Fac Med, Skopje, North Macedonia
Kalpak, O:
Univ St Cyril & Methodius, Univ Clin Cardiol, Fac Med, Skopje, North Macedonia
Calmac, L:
Clin Emergency Hosp Bucharest, Dept Cardiol, Bucharest, Romania
Vasiljevic, Z:
Univ Belgrade, Clin Ctr Serbia, Belgrade, Serbia
Knezevic, B:
Clin Ctr Montenegro, Ctr Cardiol, Podgorica, Montenegro
Dilic, M:
Univ Sarajevo, Ctr Clin, Sarajevo, Bosnia & Herceg
Milicic, D:
Univ Zagreb, Univ Hosp Ctr Zagreb, Dept Cardiovasc Dis, Zagreb, Croatia
Manfrini, O:
Univ Bologna, Dept Expt Diagnost & Specialty Med, I-40126 Bologna, Italy
Koller, A:
Univ Phys Educ, Inst Nat Sci, H-1123 Budapest, Hungary
Dorobantu, M:
Clin Emergency Hosp Bucharest, Dept Cardiol, Bucharest, Romania
Bucharest Univ Med & Pharm Carol Davila, Bucharest, Romania
Badimon, L:
Autonomous Univ Barcelona, Inst Carlos III, Cardiovasc Res Ctr, CSIC,ICCC,Hosp Santa Creu & St Pau, Barcelona, Spain
Bugiardini, R:
Univ Bologna, Dept Expt Diagnost & Specialty Med, I-40126 Bologna, Italy
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