Predictors and Long-Term Prognostic Implications of Angiographic Slow/No-Flow during Percutaneous Coronary Intervention for Acute Myocardial Infarction
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概要
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Objective In patients with acute myocardial infarction (AMI), angiographic slow/no-flow during percutaneous coronary intervention (PCI) may lead to unfavorable outcomes. The aim of our study was to investigate the predictors and long-term prognosis of AMI patients with angiographic slow/no-flow. Methods We evaluated 228 consecutive AMI patients with either normal flow (Thrombolysis in Myocardial Infarction [TIMI] flow grade 3)(n=192) or slow/no-flow (≤TIMI-2)(n=36) based on cineangiograms performed during PCI. Results Multivariable analysis demonstrated that a long lesion (≥10 mm)(odds ratio [OR], 3.514; 95% confidence interval [CI], 1.505-8.206; p=0.004) and acute hyperglycemia (≥180 mg/dl)(OR, 3.011; 95% CI, 1.211-7.485; p=0.018) were significant and independent predictors of angiographic slow/no-flow. Further, we found that there was a high correlation (89%) for predicting angiographic slow/no-flow when the optimal cut-off values of lesion length (10.45 mm) and blood glucose levels on admission (187.5 mg/dl) were combined as identified by analysis of the receiver operating characteristic curves. One-year mortality and incidence of major adverse cardiac and cerebrovascular events (MACCE) were significantly higher in the slow/no-flow group than that in the normal flow group. Angiographic slow/no-flow was independently predictive of MACCE (hazard ratio [HR], 3.642; 95% CI, 1.208-10.980; p=0.022) and cardiac death (HR, 5.287; 95% CI, 1.155-24.204; p=0.032). Conclusions Lesion length and blood glucose level on admission can be used to stratify AMI patients into a lower or higher risk for angiographic slow/no-flow before optimal coronary intervention. In addition, angiographic slow/no-flow predicts an adverse outcome in AMI patients.
- 社団法人 日本内科学会の論文
著者
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Shiode Nobuo
Department Of Cardiology Matsue Red Cross Hospital
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Chayama Kazuaki
Deparmtment Of Gastroenterology Toranomon Hospital
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Suenari Kazuyoshi
Department Of Cardiology Hiroshima University School Of Medicine
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Nakano Yukiko
Department Of Biostructural Science Graduate School Of Tokyo Medical And Dental University
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Shirota Kinya
Department Of Cardiology Matsue Red Cross Hospital
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Mikami Shinsuke
Department Of Cardiology Matsue Red Cross Hospital
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Ishii Hiroshige
Department Of Cardiology Matsue Red Cross Hospital
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Sairaku Akinori
Department Of Cardiology Chugoku Workers Compensation Hospital
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Goto Kenji
Department Of Anesthesiology And Resuscitology Okayama University Medical School
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Nakano Yukiko
Department of Medicine and Molecular Science, Graduate School of Biomedical Science, Hiroshima University
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