Clinical Analysis Of No-reflow Phenomenon After Emergency PCI In AMI Patients

PrefaceDirected PCI is an effective treatment of AMI and widely used in our country. But,no-reflow phenomenon happen often after coronary artery recanalization, which makeit impossible to provide enough blood flow to sever ischemic or nearly to necrosismyocardial cell, not all of AMI patients can get benefit from PCI because of no-reflowphenomenon. This study evaluates the incidence of no reflow phenomenon afteremergency PCI of AMI, mortality in hospital and many clinical items about no-reflowphenomenon.ObjectionTo analysis the incidence and the mortality of the no reflow phenomenon inpatients undergoing primary angioplasty(PCI) for AMI and evaluate a series of clinicalitem affecting no reflow phenomenon in order to find out relative factors affecting noflow phenomenon after PCI in AMI patients.Methods1 Clinical data: Choose consecutive 169 patients undergoing primaryangioplasty(PCI) for AMI in our hospital from March 2005 to December 2004. Allof the patients were performed stenting in IRA(infarction related artery) and weregiven aspirin(300mg) and clopidogrel(300mg) in admission. Patients were drawnblood to test cTnI, CK-MB, blood routine immediately as well as asked casehistory, physical examination and made a 18-leads ECG. patients were divided intotwo groups: no reflow group: antegrade flow of criminal vessel≤TIMI 2 afterPCI and normal reflow group: antegrade flow TIMI 3.2 Detect target:(1) Case history and physical examination: sex, age, diabetes mellitus, hypertension, hyperlipemia, family history of coronary heart disease,smoking, the number of times AMI, the history of angina pectoris beforeAMI, heart function(killip classification).(2) Examination in admission: 18-leads ECG, summary proportion (anterior wallinfarction to inferior wall infarction), test WBC(white blood cell count),CK-MB(creatine phosphokinase isoenzyme) and cTnâ… (Troponinâ… ).(3) Operation record: time from the AMI symptom beginning to criminal arteryrecanalization, single artery lesion or multiple arteries lesion, length anddegree of stegnosis of IRA, application nitroglycerin or not, the mostextension pressure during PCI, direct stenting or predilation.(4) ECG analysis: Patients were performed 18-leads ECG in admissionimmediately and 1 hour after PCI. Measure the altitude of ST segment60～80ms behind end-point of QRS(regard PR segment as the isoelectric line).Figure out the sum of ST segment elevation(∑ST) and the degree of STsegment depression STR%=(∑ST_{in admission}—∑ST_{atter PCI})/∑ST_{in admission}(5) Interventional therapy: stenting technique, the highest extension pressure wasdetermined by operator. Operation success is defined as residue stegnosis≤15% and no sandwich after stenting. If the residue stegnosis＞15%, expandby higher pressure. If the stent can't pass through the IRA, withdraw the stentand perform the predilation by smaller balloon, then set the stent. All ofinterventional therapy only deal with IRA, other lesion was handled 1 weekafter first PCI.(6) Statistics method: All of data was deal with SPSS12.0. The continuousvariable of two group was expressed to mean±standard deviation and uset-test to do analysis; Classification variable was tested by X² chi-squarecriterion. P＜0.05 is regard as Statistics significance.Results1 In 169patients of this study, 29 patients(17.2ï¼…)appear no reflow phenomenon,140 patients appear normal blood flow.2 There was no difference in term of mean age, sex, diabetes, hypertension,hyperlipoidemia, family history, smoking, the site of AMI, the length and degree of lesion of criminal vessel, the percentage of single artery lesion, the percentage offirst AMI, the percentage of application nitroglycerin during PCI.3 There were statistically significant differences in term of the time from the AMIsymptom beginning to criminal artery recanalization (7.9±1.9h vs 4.1±1.1h; P＜0.01), heart function≥Ⅱ(killip classification) (31.0ï¼…vs 7.1%,P＜0.01),mean WBC count (14.3±3.7)×10⁹/Lvs(7.4±2.5)×10⁹/L, P＜0.01, CK-MB(53.2±10.3 vs 28.5±6.1U/1; P＜0.01)and troponin-â… (7.8±2.1ng/mlvs 2.3±1.1ng/mL; P＜0.01), the degree of ST segment reduction in ECG, absence ofangina pectoris history before AMI, the percentage of directing stenting, thehighest extension pressure during PCI between two groups.4 Total mortality: 5.3ï¼…(9/169), no reflow group: 13.8ï¼…(4/29), normal reflowgroup: 3.6ï¼…(5/140), P＜0.001.Conclusion1 No reflow phenomenon after PCI in AMI is related with factors as below: absenceof angina pectoris history, long time from the AMI symptom beginning to criminalartery recanalization, low heart function on admission, high WBC count, high levelof CK-MB and troponin-â… , predilation before stenting, the high extension pressureetc.2 he ECG ST segment of patients with no reflow reduce slowly.3 The mortality of no reflow patients is higher than normal reflow patients.4 No reflow after PCI suggests unfavourable prognosis.