BACKGROUND: Despite major advances in interventional cardiology in recent years, no-reflow is still observed during percutaneous coronary interventions (PCI), and is associated to a worse prognosis. The objective of this study was to characterize the clinical, angiographic and procedural profile of patients with no-reflow as well as assessing its late clinical impact. METHODS: From January 2004 to February 2009, patients undergoing PCI at the Instituto do Coração (InCor), presenting no-reflow at any time during the intervention, were evaluated. Patients were divided into two groups: reperfusion no-reflow (associated to primary PCI) and interventional no-reflow (associated to elective PCI). The probability of death was estimated by the Kaplan-Meier method and Cox regression was used to identify its predictors. RESULTS: One hundred and thirty-two consecutive patients were evaluated, 81 in the reperfusion no-reflow group and 51 in the interventional no-reflow group. Procedural success was observed in 83.5% of the overall population (80.2% vs. 90.2%, respectively; P = 0.149). The long-term probability of death was estimated at 38.6%, and was higher in the reperfusion no-reflow group (55.8% vs. 11.1%; P = 0.005). In the multivariate analysis, only female gender [hazard ratio (HR) 2.5, 95% confidence interval (95% CI) 1.225.14; P = 0.027) and chronic obstructive pulmonary disease (HR 9.35, CI 95% 1.45-60.14; P = 0.027) were independent predictors of mortality, whereas the prior use of statin was a protective factor (HR 0.15, 95% CI 0.05-0.48; P = 0.002). CONCLUSIONS: The no-reflow phenomenon was associated with high procedural failure rates and long-term mortality, especially when associated to primary angioplasty.
Mortality; Myocardial infarction; Angioplasty, transluminal, percutaneous coronary; Reperfusion
