FEATURES AND OUTCOME OF NO-REFLOW AFTER PERCUTANEOUS CORONARY INTERVENTION
FEATURES AND OUTCOME OF NO-REFLOW AFTER PERCUTANEOUS CORONARY INTERVENTION
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DOI：
10.1016/s0002-9149(99)80410-x
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发表时间：
1995-04-15
影响因子：
2.8
通讯作者：
SAFIAN, RD
中科院分区：
文献类型：
--
作者：
ABBO, KM;DOORIS, M;SAFIAN, RD
无复流是一种罕见的并发症，可能发生在急性心肌梗死患者血运重建后、大隐静脉旁路移植术后以及使用一些新型介入器械后。然而，冠状动脉介入治疗后无复流的临床影响尚不清楚。因此，本研究检查了经皮冠状动脉介入治疗后无复流的发生率、临床表现、血管造影特征和结果。无复流被定义为顺行血流急剧减少（小于或等于 1，根据心肌梗死溶栓 [TIMI] 试验的定义），而不是由于原始目标病变的突然闭合、高度狭窄或痉挛。 1988年10月至1993年6月期间进行的10,676例冠状动脉介入治疗中，66名患者（0.6%）没有发生复流。将这些患者与未表现出无复流的 500 名连续患者组成的亚组进行比较。经皮腔内冠状动脉成形术的无复流发生率为 9,431 例中的 30 例（0.3%），准分子激光为 317 例中的 1 例（0.3%），旋转器（Heart Technologies，贝尔维尤，华盛顿）为 104 例中的 8 例（7.7%），摘除斑块旋切术中的 469 例中为 21 例（4.5%），以及 355 例中的 6 例。 (1.7%) 用于定向斑块旋切术。与无复流患者相比，无复流患者的院内死亡（15%）和急性心肌梗死（31%）发生率高出10倍。院内死亡率的相关因素包括就诊时的急性心肌梗死（p = 0.006）和手术完成时的最终流量< 3（根据 TIMI 试验的定义）（p = 0.03）。 66 名患者中，只有 19 名患者 (29%) 成功解决了无复流问题，范围从单独使用尿激酶的 10% 到冠状动脉内维拉帕米的 67%。按设备计算，旋转器后无复流的分辨率为 63%，血管成形术后为 37%，定向斑块旋切术后为 33%，提取式旋切术后为 5%，准分子激光后为 0%。总之，无复流很少发生，但由于随后死亡和心肌梗死的发生率很高，因此在临床上很重要。在急性心肌梗死的情况下以及使用新的斑块切除装置后，无复流的发生率较高。未能使流量正常化与不良结果相关。
No-reflow is an uncommon complication that may occur after revascularization of patients with acute myocardial infarction, after interventions in saphenous vein bypass grafts, and after the use of some new interventional devices. However, the clinical impact of no-reflow after coronary intervention is unknown. Accordingly, this study examined the incidence, clinical presentation, angiographic characteristics, and outcome of no-reflow after percutaneous coronary intervention. No-reflow was defined as an acute reduction in antegrade flow (less than or equal to 1, as defined by the Thrombolysis in Myocardial Infarction [TIMI] trial) not attributable to abrupt closure, high-grade stenosis, or spasm of the original target lesion. Among 10,676 coronary interventions performed between October 1988 and June 1993, no-reflow occurred in 66 patients (0.6%). These patients were compared with a subgroup of 500 consecutive patients who did not exhibit no-reflow. The incidence of no-reflow was 30 of 9,431 (0.3%) for percutaneous transluminal coronary angioplasty, 1 of 317 (0.3%) for excimer laser, 8 of 104 (7.7%) for Rotablator (Heart Technologies, Bellevue, Washington), 21 of 469 (4.5%) for extraction atherectomy, and 6 of 355 (1.7%) for directional atherectomy. Compared with those without no-reflow, patients with no-reflow experienced a 10-fold higher incidence of in-hospital death (15%) and acute myocardial infarction (31%). Correlates of in-hospital mortality included acute myocardial infarction on presentation (p = 0.006) and final flow < 3 (as defined by the TIMI trial) at completion of the procedure (p = 0.03). Successful resolution of no-reflow was observed in only 19 of 66 patients (29%), and ranged from 10% with urokinase alone to 67% with intracoronary verapamil. By device, resolution of no-reflow was 63% after the Rotablator, 37% after angioplasty, 33% after directional atherectomy, 5% after extraction atherectomy, and 0% after excimer laser. In conclusion, no-reflow occurs infrequently but is clinically important because of the high incidence of subsequent death and myocardial infarction. The incidence of no-reflow is higher in the setting of acute myocardial infarction and after new atherectomy devices. Failure to normalize flow is associated with a poor outcome.