Predictores clínicos de no-reflujo en la angioplastia coronaria por infarto agudo de miocardio

Gagliardi, Juan; Szarfer, Jorge; Travetto, Carolina; Escudero, Alejandro García; Gigena, Gerardo; Rodriguez, Andrea C.; Alonso, Analía; Blanco, Federico Carlos; Sarmiento, Ricardo; Riccitelli, Miguel Ángel

doi:10.7775/rac.es.v81.i3.1423

Cited by 3 publications

(5 citation statements)

References 19 publications

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“…Nevertheless, a study by Gagliard et al [20], which included 742 individuals suffering from acute MI treated with primary PCI within October 2001 and May 2011, discovered that heart failure was substantially more prevalent in patients with no-reflow (17.6% versus 10.1%; P value = 0.01) at the time of admission.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Visible Thrombus Aspiration Material and No Reflow with Its Impact on In-hospital Mortality and Early Outcomes in Patients with ST-elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Abdallah

Elshedoudy

Hamdy

et al. 2023

JAMMR

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Background: The no-reflow phenomenon is critical and, if not reversed, causes a high rate of morbidity and mortality. It was demonstrated that the no-reflow phenomenon after Primary percutaneous coronary intervention (pPCI) is a strong predictor of mortality after the acute event in patients with STEMI. The aim of this study was to investigate the impact of visible thrombus aspiration (VTA) material on no reflow and its relation to hospital mortality and early outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Methods: This prospective observational study conducted on 100 patients admitted with acute STEMI and treated with primary PCI within 24 hours of presentation. Patients were divided into two groups: Group VTA (n=58): who had visible thrombus aspiration material (VTA) (defined as collected visible aspiration material, including atherothrombotic debris or thrombus) & Group non VTA (n=42): who had non-VTA (defined as no visible aspiration material and only blood). Results: There was significant statistical difference between group VTA & Group non VTA as regard No reflow after aspiration(15.5%vs 45.5%, P =0.001), In hospital mortality (0% vs 9.5% ,P = 0.016), LVEF at hospital (47.90 ± 5.38 vs 42.36 ± 5.95, P =0.001) and LVEF after 1 month (51.90 ± 4.36 vs 48.83 ± 4.53, P =0.001). However, there was no significant statistical difference between both groups as regard baseline TIMI flow, syntax score, in-hospital MACE, length of hospital stays. Conclusions: Our study resulted in aspiration of macro visible thrombus materials led to lower rates of no reflow after aspiration and better short-term clinical outcomes and prognosis than those patients with non-visible thrombus aspiration materials with ST-elevation myocardial infarction treated with pPCI.

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Section: Discussionmentioning

confidence: 99%

The Relationship between Visible Thrombus Aspiration Material and No Reflow with Its Impact on In-hospital Mortality and Early Outcomes in Patients with ST-elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Abdallah

Elshedoudy

Hamdy

et al. 2023

JAMMR

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“…El NRF u obstrucción microvascular, es una entidad referida a la imposibilidad de reperfundir la microcirculación coronaria en una región previamente isquémica, a pesar de la apertura del vaso epicárdico, lo cual conlleva a efectos adversos intrahospitalarios y a largo plazo (7)(8)(9)(10)(14)(15)(16) . En el presente estudio se encontró que el tiempo total de isquemia mayor a 12 h, el KK > 1, la lesión uniarterial y el flujo inicial TIMI 0 pre-ICP fueron los marcadores independientes de no reflujo.…”

Section: Discussionunclassified

“…La evaluación del NRF puede darse de distintas maneras (8)(9)(17)(18)(19) , por tanto, su incidencia varía según el método diagnóstico empleado y el contexto clínico. El presente estudio, por basarse en un análisis retrospectivo, la información que se tomó para la evaluación de NRF fue el score de flujo TIMI reportado, que, pese a considerarse una evaluación semicuantitativa, subjetiva y menos sensible, ya en estudios previos como el de Morishima et al se ha reportado útil para señalar la importancia de este fenómeno como un predictor independiente de eventos adversos (19) .…”

Section: Discussionunclassified

“…La incidencia de NRF en el contexto de un IAMCEST, se presenta (dependiendo de la población y el método diagnóstico utilizado) entre un 5 a 50% de las ICP; su fisiopatología involucra el daño relacionado a la isquemia, el daño relacionado a la reperfusión, la disfunción endotelial, el tromboembolismo distal, y el espasmo microvascular (9,10) . Las consecuencias del NRF son el remodelado ventricular adverso, la expansión del área del infarto, la mayor incidencia de arritmias ventriculares e insuficiencia cardíaca, siendo un predictor independiente de mal pronóstico en el infarto agudo de miocardio, con peores resultados clínicos a corto y largo plazo como mayor falla cardiaca, choque cardiogénico y muerte (8)(9)(10) .…”

Section: Introductionunclassified

“…La presencia del no reflujo (NRF) puede evaluarse de distintas maneras: a) en la angiografía a través de técnicas como el score TIMI (flujo < 3 sin una obstrucción residual significativa, disección, espasmo o trombosis in situ), el blush miocárdico (MBG) o el conteo de cuadros TIMI (del inglés TIMI frame count (TFC)) y mediciones invasivas como el índice de resistencia microvascular (IRM) y la reserva de flujo coronario (RFC); b) mediante técnicas de imagen no invasivas como el ecocardiograma miocárdico con contraste, la resonancia magnética con gadolinio o imágenes de medicina nuclear; o c) a través del uso del electrocardiograma posterior a la ICP, midiendo la resolución del segmento ST 8 , 9 .…”

Section: Introductionunclassified

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Clinical variables associated with no-reflow after percutaneous coronary intervention in ST-segment elevation myocardial infarction: Secondary analysis of the PERSTEMI I and II study

Paredes-Paucar

Custodio-Sánchez²,

Chacón-Díaz

2022

Arch Peru Cardiol Cir Cardiovasc

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Objetivo. Determinar las variables clínicas asociados a no reflujo tras la intervención coronaria percutánea (ICP) en pacientes con infarto de miocardio con elevación del segmento ST (IAMCEST) en el Perú. Materiales y métodos. Estudio de casos y controles retrospectivo, derivado de los registros PERSTEMI (registro peruano de infarto de miocardio con elevación del segmento ST) I y II. Se consideró casos (grupo 1) a los pacientes que presentaronnoreflujotraslaICP,definidoporunflujoTIMI<3,ycontroles(grupo2)aaquellosconunflujoTIMI 3 post intervención. Se compararon variables clínicas y angiográficas entre ambos grupos y se realizó un análisis multivariable buscando variables independientes asociados a no reflujo. Resultados. Se incluyeron 75 casos y 304 controles. La incidencia de no reflujo fue del 19,8%. Se presentó mayor frecuencia de no reflujo en pacientes sometidos a ICP primaria en comparación a farmacoinvasiva, además en pacientes con lesiones uniarteriales y en aquellos con flujo inicial TIMI 0. La mortalidad hospitalaria y la incidencia de insuficiencia cardiaca fue mayor en los pacientes con no reflujo (21,3% vs. 2,9% y 45,3% vs. 16,5%, respectivamente, valor de p < 0,001). Posterior al análisis multivariado se encontró que el tiempo de isquemia > 12 h, un Killip Kimball (KK) > I, un flujo inicial TIMI 0, y la enfermedad uniarterial, fueron las variables asociadas de forma significativa a no reflujo tras la ICP. Conclusiones. El tiempo de isquemia mayor a 12 h, el mayor puntaje KK, la presencia de flujo TIMI 0 en la arteria responsable del infarto pre-ICP y la enfermedad coronaria uniarterial son variables que se asocian de forma independiente la posibilidad de no reflujo en pacientes con IAMCEST en el Perú.

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No-Reflow after PPCI—A Predictor of Short-Term Outcomes in STEMI Patients

Pantea-Roșan

Pantea

Bungău

et al. 2020

JCM

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The no-reflow phenomenon following primary percutaneous coronary intervention (PPCI) in acute ST-elevation myocardial infarction (STEMI) patients is a predictor of unfavorable prognosis. Patients with no-reflow have many complications during admission, and it is considered a marker of short-term mortality. The current research emphasizes the circumstances of the incidence and complications of the no-reflow phenomenon in STEMI patients, including in-hospital mortality. In this case-control study, conducted over two and a half years, there were enrolled 656 patients diagnosed with STEMI and reperfused through PPCI. Several patients (n = 96) developed an interventional type of no-reflow phenomenon. One third of the patients with a no-reflow phenomenon suffered complications during admission, and 14 succumbed. Regarding complications, the majority consisted of arrhythmias (21.68%) and cardiogenic shock (16.67%). The anterior localization of STEMI and the left anterior descending artery (LAD) as a culprit lesion were associated with the highest number of complications during hospitalization. At the same time, the time interval >12 h from the onset of the typical symptoms of myocardial infarction (MI) until revascularization, as well as multiple stents implantations during PPCI, correlated with an increased incidence of short-term complications. The no-reflow phenomenon in patients with STEMI was associated with an unfavorable short-term prognosis.

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Predictores clínicos de no-reflujo en la angioplastia coronaria por infarto agudo de miocardio

Cited by 3 publications

References 19 publications

The Relationship between Visible Thrombus Aspiration Material and No Reflow with Its Impact on In-hospital Mortality and Early Outcomes in Patients with ST-elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

The Relationship between Visible Thrombus Aspiration Material and No Reflow with Its Impact on In-hospital Mortality and Early Outcomes in Patients with ST-elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Clinical variables associated with no-reflow after percutaneous coronary intervention in ST-segment elevation myocardial infarction: Secondary analysis of the PERSTEMI I and II study

No-Reflow after PPCI—A Predictor of Short-Term Outcomes in STEMI Patients

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