| 홍영준, 정명호, 안영근, 정해창, 윤남식, 윤현주, 문재연, 김계훈, 박형욱, 김주한, 조정관, 박종춘, 강정채 |
Background: Severe embolization during percutaneous coronary intervention (PCI) may result in the no-reflow phenomenon, and the occurrence of which is associated with about 15% rate of mortality.
Objectives: The purpose of this study was to evaluate which factors are related with no-reflow after PCI in patients with acute myocardial infarction (AMI).
Methods: Between November, 2005 and December 2006, 621 patients were admitted for AMI (439 ST segment elevation MI and 182 non-ST segment elevation MI) and the study group comprised 577 patients who underwent PCI for infarct-related artery. Angiographic no-reflow was defined as post-PCI TIMI flow grade 0, 1, and 2.
Results: Of 577 patients underwent PCI, no-reflow was observed in 33 patients at post-PCI (6%). No-reflow group had higher high-sensitivity C-reactive protein (hs-CRP) levels compared to normal reflow group (3.9±4.7 mg/dl vs. 2.1±3.1 mg/dl, p=0.049). There was a strong tendency that creatinine clearance was lower and stent length was longer in no-reflow group compared with normal reflow group (59±33 ml/min vs. 70±37 ml/min, p=0.089, and 27±5 mm vs. 25±5 mm, p=0.074, respectively). No-reflow group had lower ejection fraction and higher echocardiographic total wall motion score compared with normal reflow group (49.6±12.0% vs. 55.8±12.5%, p=0.007, and 22.8±5.8 vs. 19.4±4.2, p<0.001, respectively). On diagnostic coronary angiogram, pre-PCI TIMI 0 flow and complex lesions (ACC/AHA type B2/C lesion) were observed more frequently in no-reflow group compared with normal reflow group (64% vs. 45%, p=0.039, and 76% vs. 67%, p=0.016, respectively). Multivariate logistic regression analysis showed that elevated hs-CRP was the only independent predictor of post-PCI no-reflow phenomenon (Hazard ratio: 2.484, 95% CI: 1.087-5.677, p=0.031).
Conclusions: Elevated hs-CRP is associated with no-reflow after PCI for infarct-related artery in patients with AMI. Our findings suggest that early initiation of anti-inflammatory therapy such as statins is needed before PCI in AMI patients.
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