Predictive factors for development of the no-reflow phenomenon in patientswith reperfused anterior wall acute myocardial infarction

OBJECTIVES We sought to elucidate the clinical factors related to the devel opment of no-reflow phenomenon after successful coronary reperfusion in pat ients with an acute myocardial infarction (AMI). BACKGROUND Myocardial contrast echocardiography revealed that the no-reflow phenomenon is observed in some patients with a reperfused AMI, and those p atients usually have poor functional and clinical outcomes. It is still unk nown what clinical factors are related to the development of the no-reflow phenomenon. METHODS Myocardial contrast echocardiography was performed 15 min after suc cessful coronary reperfusion therapy in 199 patients with an anterior wall AMI who underwent successful coronary reperfusion with primary coronary ang ioplasty within 24 h after the onset of AMI. Multiple logistic regression a nalysis was used to identify independent predictors of the no-reflow phenom enon. RESULTS Seventy-nine patients showed the no-reflow phenomenon. Univariate a nalysis indicated that pre-infarction angina within 48 h before symptom ons et, Killip class, Thrombolysis in Myocardial Infarction flow grade 0 on the initial coronary angiogram, the number of abnormal Q-waves and the wall mo tion score ( WS) on the echocardiogram obtained at hospital admission are r elated to the no-reflow phenomenon. Multivariate logistic regression analys is revealed that all of these factors, except fur Killip class, are indepen dent predictive factors of the no-reflow phenomenon. CONCLUSIONS Development of the no-reflow phenomenon is related to the sever ity of myocardial damage (number of Q-waves), the size of the risk area (WM S) and the occlusion status of infarct-related artery. In addition, ischemi c preconditioning (pre-infarction angina) seems to be the factor that atten uates the no-reflow phenomenon. (J Am Coll Cardiol 2001;38:472-7) 2001 by t he American College of Cardiology.