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Revista Uruguaya de Cardiología

Print version ISSN 0797-0048On-line version ISSN 1688-0420

Abstract

GUTIERREZ, Rodolfo et al. No-reflow phenomenon in coronary angioplasty: incidence, clinical-angiographic characteristics and efficacy of treatment. Rev.Urug.Cardiol. [online]. 2018, vol.33, n.3, pp.64-95. ISSN 0797-0048.  http://dx.doi.org/10.29277/cardio.33.3.7.

Introduction:

no-reflow phenomenon is defined as persistence of inadequate flow less than TIMI 3 during coronary angioplasty in the absence of an obstacle in epicardial coronary arteries. Primary endpoint: to determine the incidence of no-reflow in patients treated with coronary angioplasty performed for any indication. Secondary endpoints: to describe the clinical and angiographic characteristics, procedural characteristics, treatment and prognostic value of no-reflow phenomenon.

Methods:

this is an observational, prospective and unicentric trial including all coronary angioplasties performed in an interventional Cardiology center between October 2016 and January 2017, excluding instent reestenosis and coronary vein grafts disease. Two groups were defined: control (normal coronary flow) and no-reflow phenomenon. Clinical, angiographic and prognostic variables were analyzed.

Results:

322 patients were included, 291 control and 31 no-reflow. No-reflow incidence was 9.6%, occurring in 20.7% of acute coronary syndromes with ST segment elevation, 6.3% in non-ST segment elevation syndromes and 3% in stable coronary artery disease. High dose adenosine was the most frequently used agent for no-reflow treatment. No-reflow treatment was associated with a significant improvement in coronary flow measured by TIMI Frame Count (39.4±1.6 pretreatment vs 21.9±1.2 postreatment, p<0.001). At 3 month follow up, no-reflow patients vs control had a higher incidence of angina pectoris (6.6% vs 1.1% respectively, p=0.001), coronary angiography (10% vs 1.1%, p=0.017) and coronary angioplasty (19% vs 1.1%, p=0.009).

Conclusions:

no-reflow incidence in patients treated with coronary angioplasty was 9.6%, occurring more frequently in ST segment elevation syndromes. High dose adenosine was the most frequently used agent for no-reflow treatment and significantly improved coronary flow.

Keywords : No-Reflow phenomenon; Coronary angioplasty; Adenosine; TIMI frame count.

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