Incidence, Predictors, and Prognosis of Coronary Slow-Flow and No-Reflow Phenomenon in Patients with Chronic Total Occlusion Who Underwent Percutaneous Coronary Intervention
Authors Wang Y, Zhao H, Wang C, Zhang X, Tao J, Cui C, Meng Q, Zhu Y, Luo D, Hou A, Luan B
Received 5 October 2019
Accepted for publication 4 February 2020
Published 18 February 2020 Volume 2020:16 Pages 95—101
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Deyun Wang
Yong Wang, Hong-wei Zhao, Cheng-fu Wang, Xiao-jiao Zhang, Jie Tao, Chun-sheng Cui, Qing-kun Meng, Yu Zhu, De-feng Luo, Ai-jie Hou, Bo Luan
Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, Shenyang City, Liaoning Province, 110016, People’s Republic of China
Correspondence: Ai-jie Hou; Bo Luan
Department of Cardiology, The People’s Hospital of China Medical University, the People’s Hospital of Liaoning Province, No. 33, Wenyiroad, Shenhe District, Shenyang City, Liaoning Province 110016, People’s Republic of China
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Background: The incidence and prognosis of coronary slow-flow (CSF) and no-reflow phenomenon (NRP) in patients with coronary chronic total occlusion (CTO) who underwent percutaneous coronary intervention (PCI) remain unclear.
Methods: This single-center prospective study aimed to investigate the incidence of CSF/NRP during CTO interventional therapy, determine predictors of CSF/NRP, and evaluate its effect on patient outcomes.
Results: In this study, 552 patients with CTO who underwent PCI were included. CSF/NRP occurred in 16.1% of them. They had higher incidences of diabetes mellitus (53.9% vs 36.3%, p=0.002) and hypertension (50.6% vs 37.1%, p=0.018) and a lower incidence of retrograde filling grade > 2 (34.8% vs 47.1%, p=0.036). Patients with CSF/NRP had a higher neutrophil ratio (55.6± 19.4 vs 52.4± 18.3, p=0.038) and levels of low-density lipoprotein (LDL; 3.0± 0.8 vs 2.8± 0.6, p=0.029), fasting glucose (FG; 8.3± 1.3 vs 6.8± 1.1, p=0.005), uric acid (332.6± 82.9 vs 308.2± 62.8, p=0.045), and high-sensitivity C-reactive protein (Hs-CRP; 9.8± 4.8 vs 7.3± 3.9, p=0.036). A multivariate logistic regression analysis revealed that diabetes mellitus (odds ratio [OR], 1.962; 95% confidence interval [CI]: 1.198– 2.721; p=0.042), mean platelet volume (MPV; OR,1.284; 95% CI, 1.108– 1.895; p=0.046), LDL cholesterol (LDL-C; OR, 1.383; 95% CI, 1.105– 2.491; p=0.036), FG (OR, 2.095; 95% CI, 1.495– 2.899; p=0.018), Hs-CRP(OR, 2.218; 95% CI, 1.556– 3.519; p=0.029), and retrograde filling of grade > 2 (OR, 0.822; 95% CI, 0.622– 0.907; p=0.037) were independent predictors of CSF/NRP in CTO patients who underwent PCI. Kaplan-Meier analysis revealed that the patients in the CSF/NRP group had a significantly lower cumulative major cardiac and cerebrovascular events (MACCE)-free survival than those in the non-CSF/NRP group (p< 0.0001).
Conclusion: Of the patients with CTO who underwent PCI, 16.1% developed CSF/NRP and had a significantly lower cumulative MACCE-free survival rate. Diabetes mellitus; higher levels of MPV, LDL-C, FG, and Hs-CRP; and a lower incidence of retrograde filling grade > 2 were independent predictors of CSF/NRP in CTO patients who underwent PCI. Thus, they can be used for risk stratification.
Keywords: coronary slow-flow, no-reflow phenomenon, coronary chronic total occlusion, PCI, prognosis
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