• Young-Hoon Jeong, Won-Jang Kim, Duk-Woo Park, Bong-Ryong Choi, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Myeong-Ki Hong, Jae-Joong Kim, Seong-Wook Park, and Seung-Jung Park.
• Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.
• Int. J. Cardiol. 2010 May 28; 141 (2): 175-81.

BackgroundThe angiographic 'no-reflow' phenomenon after primary percutaneous coronary intervention (PPCI) is associated with a poor short-term and long-term clinical prognosis of ST-elevation myocardial infarction (STEMI). Although the increasing use of primary drug-eluting stent (DES) deployment for STEMI resulted in reduced adverse clinical outcomes, the prevalence of no-reflow has been unchanged. The purpose of our study was to evaluate the predictors for no-reflow for STEMI and identify such high-risk patients in the DES era.MethodsThe study prospectively enrolled 300 consecutive STEMI patients (80% men; 57+/-11 years) who underwent PPCI within 12 h of symptom onset. The no-reflow phenomenon was defined as an angiographic outcome of Thrombolysis In Myocardial Infarction (TIMI) grade <3 without accompanying mechanical factors.ResultsCompared to normal reflow patients, no-reflow patients (n=15, 5% of the total study population) were older (64+/-13 vs. 57+/-11 years; P=0.019), transferred to hospital later (7.1+/-3.2 vs. 4.5+/-3.8 h; P=0.011), and had a higher TIMI risk score (5.5+/-2.0 vs. 3.8+/-2.2; P=0.004). B-type natriuretic peptide (BNP), high sensitivity C-reactive protein, and serum creatinine levels were higher in the no-reflow than the normal reflow group. Multivariate analysis (including clinical, angiographic and procedural variables with a P<0.2 in univariate analysis) showed that high BNP level on admission was the only independent predictor of no-reflow. The area under the receiver-operating characteristics curve analysis value for BNP was 0.786. BNP > or =90 pg/ml showed a sensitivity of 80% and a specificity of 70% for predicting no-reflow after primary DES implantation (OR 14.953, 95% CI 3.131-71.419, P=0.001).ConclusionsAngiographic 'no-reflow' phenomenon after primary DES implantation for STEMI can be predicted by BNP levels on admission. BNP-guided approach may be useful in identifying patients at high risk of the no-reflow phenomenon after primary stenting.Copyright 2008 Elsevier Ireland Ltd. All rights reserved.

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