期刊
EUROINTERVENTION
卷 14, 期 2, 页码 185-193出版社
EUROPA EDITION
DOI: 10.4244/EIJ-D-17-00269
关键词
acute coronary syndrome; myocardial infarction; non-ST-elevation myocardial infarction; ST-elevation myocardial infarction
资金
- National Health and Medical Research Council of Australia (NHMRC) [APP1052960]
- NHMRC Senior Research Fellowship [APP1045862]
- NHMRC grant
- NHMRC [APP 1115163]
- National Heart Foundation Health Professional Scholarship [101130]
- Abbott
- AstraZeneca
- Medtronic
- MSD
- Pfizer
- Servier
- Medicines Company
Aims: The aim of the study was to evaluate long-term outcomes of transient versus persistent no-reflow. Methods and results: A total of 17,547 patients with normal flow post percutaneous coronary intervention (PCI) were compared to 590 patients (3.2%) with transient no-reflow and 144 patients (0.8%) with persistent no-reflow. Long-term all-cause mortality was obtained by linkage with the National Death Index (NDI). No-reflow patients were more likely to have presented with ST-elevation myocardial infarction (STEM), out-of-hospital cardiac arrest (OHCA) or cardiogenic shock (all p<0.01). Long-term NDI-linked all-cause mortality was highest in patients with persistent no-reflow (31%) followed by transient no-reflow (22%) and normal flow (14%) over a median follow-up of 5.2, 5.5 and 4.5 years, respectively (all p<0.0001). Kaplan-Meier survival estimates demonstrated a graded increase in all-cause mortality from normal flow, to transient to persistent no-reflow (p<0.01), with the highest mortality occurring early (<30 days) in the persistent no-reflow group (p<0.0001). Multivariate Cox proportional hazards modelling identified glomerular filtration rate <30 mL/min, ejection fraction <30%, persistent no-reflow and transient no-reflow as independent predictors of increased hazard for all-cause mortality (all p<0.05). Conclusions: Transient and persistent no-reflow were associated with a stepwise reduction in long-term survival. The presence of even transient no-reflow appears to be an important predictor of adverse long-term outcome.
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