Renal Dysfunction as a Predictor of Slow-Flow/No-Reflow Phenomenon and Impaired ST Segment Resolution After Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction With Initial Thrombolysis in Myocardial Infarction Grade 0
Background:The slow-flow/no-reflow phenomenon and impaired ST segment resolution (STR) following primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) predict unfavorable prognosis and are characterized by obstruction of the coronary microvascular. Several pr...
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| Veröffentlicht in: | Circulation Journal 2021/09/24, Vol.85(10), pp.1770-1778 |
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| creator | Kai, Takahiko Oka, Satoshi Hoshino, Katsuomi Watanabe, Kazunori Nakamura, Jun Abe, Makoto Watanabe, Akinori |
| description | Background:The slow-flow/no-reflow phenomenon and impaired ST segment resolution (STR) following primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) predict unfavorable prognosis and are characterized by obstruction of the coronary microvascular. Several predictors of slow-flow/no-reflow have been revealed, but few studies have investigated predictors of slow-flow/no-reflow and STR exclusively in acute myocardial infarction patients with initial Thrombolysis in Myocardial Infarction (TIMI) Grade 0.Methods and Results:In all, 279 STEMI patients with initial TIMI Grade 0 were enrolled in the study. Slow-flow/no-reflow was defined as TIMI Grade |
| doi_str_mv | 10.1253/circj.CJ-21-0221 |
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Several predictors of slow-flow/no-reflow have been revealed, but few studies have investigated predictors of slow-flow/no-reflow and STR exclusively in acute myocardial infarction patients with initial Thrombolysis in Myocardial Infarction (TIMI) Grade 0.Methods and Results:In all, 279 STEMI patients with initial TIMI Grade 0 were enrolled in the study. Slow-flow/no-reflow was defined as TIMI Grade <3 by angiography after PCI, and impaired STR was defined as STR <50% on an electrocardiogram after PCI. Slow-flow/no-reflow was observed in 31 patients. In multivariate analysis, estimated glomerular filtration rate (eGFR; odds ratio [OR] 0.97; P=0.007), a history of cerebrovascular disease (OR 4.65, P=0.007), time to recanalization ≥4 h (OR 2.76, P=0.023), and systolic blood pressure ≤90 mmHg (OR 3.45, P=0.046) were independent predictors of slow-flow/no-reflow. Impaired STR was observed in 102 of 248 patients with TIMI Grade 3. In multivariate analysis, eGFR (OR 0.94, P<0.001) and occlusion of the left anterior descending artery (OR 4.48, P<0.001) were independent predictors of impaired STR; eGFR was the only independent predictor of both slow-flow/no-reflow and impaired STR.Conclusions:Renal dysfunction may be related to coronary microvascular dysfunction and obstruction.</description><identifier>ISSN: 1346-9843</identifier><identifier>ISSN: 1347-4820</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-21-0221</identifier><identifier>PMID: 34305099</identifier><language>eng</language><publisher>Japan: The Japanese Circulation Society</publisher><subject>Coronary Angiography ; Humans ; Kidney Diseases ; Myocardial Infarction ; No reflow ; No-Reflow Phenomenon - diagnostic imaging ; No-Reflow Phenomenon - etiology ; Percutaneous Coronary Intervention - adverse effects ; Renal dysfunction ; ST Elevation Myocardial Infarction - diagnostic imaging ; ST Elevation Myocardial Infarction - therapy ; ST-elevation myocardial infarction (STEMI) ; Thrombolytic Therapy</subject><ispartof>Circulation Journal, 2021/09/24, Vol.85(10), pp.1770-1778</ispartof><rights>2021, THE JAPANESE CIRCULATION SOCIETY</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-88f63c6f3cec09074c0d76733bf277748186656b05a51dce27538cd4d84b9ea3</citedby><cites>FETCH-LOGICAL-c495t-88f63c6f3cec09074c0d76733bf277748186656b05a51dce27538cd4d84b9ea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1877,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34305099$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kai, Takahiko</creatorcontrib><creatorcontrib>Oka, Satoshi</creatorcontrib><creatorcontrib>Hoshino, Katsuomi</creatorcontrib><creatorcontrib>Watanabe, Kazunori</creatorcontrib><creatorcontrib>Nakamura, Jun</creatorcontrib><creatorcontrib>Abe, Makoto</creatorcontrib><creatorcontrib>Watanabe, Akinori</creatorcontrib><title>Renal Dysfunction as a Predictor of Slow-Flow/No-Reflow Phenomenon and Impaired ST Segment Resolution After Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction With Initial Thrombolysis in Myocardial Infarction Grade 0</title><title>Circulation Journal</title><addtitle>Circ J</addtitle><description>Background:The slow-flow/no-reflow phenomenon and impaired ST segment resolution (STR) following primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) predict unfavorable prognosis and are characterized by obstruction of the coronary microvascular. Several predictors of slow-flow/no-reflow have been revealed, but few studies have investigated predictors of slow-flow/no-reflow and STR exclusively in acute myocardial infarction patients with initial Thrombolysis in Myocardial Infarction (TIMI) Grade 0.Methods and Results:In all, 279 STEMI patients with initial TIMI Grade 0 were enrolled in the study. Slow-flow/no-reflow was defined as TIMI Grade <3 by angiography after PCI, and impaired STR was defined as STR <50% on an electrocardiogram after PCI. Slow-flow/no-reflow was observed in 31 patients. In multivariate analysis, estimated glomerular filtration rate (eGFR; odds ratio [OR] 0.97; P=0.007), a history of cerebrovascular disease (OR 4.65, P=0.007), time to recanalization ≥4 h (OR 2.76, P=0.023), and systolic blood pressure ≤90 mmHg (OR 3.45, P=0.046) were independent predictors of slow-flow/no-reflow. Impaired STR was observed in 102 of 248 patients with TIMI Grade 3. In multivariate analysis, eGFR (OR 0.94, P<0.001) and occlusion of the left anterior descending artery (OR 4.48, P<0.001) were independent predictors of impaired STR; eGFR was the only independent predictor of both slow-flow/no-reflow and impaired STR.Conclusions:Renal dysfunction may be related to coronary microvascular dysfunction and obstruction.</description><subject>Coronary Angiography</subject><subject>Humans</subject><subject>Kidney Diseases</subject><subject>Myocardial Infarction</subject><subject>No reflow</subject><subject>No-Reflow Phenomenon - diagnostic imaging</subject><subject>No-Reflow Phenomenon - etiology</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Renal dysfunction</subject><subject>ST Elevation Myocardial Infarction - diagnostic imaging</subject><subject>ST Elevation Myocardial Infarction - therapy</subject><subject>ST-elevation myocardial infarction (STEMI)</subject><subject>Thrombolytic Therapy</subject><issn>1346-9843</issn><issn>1347-4820</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptUcFy2yAQ1XTaadK09546HHtRgkBI6JhxE9eZtPXYnumRQWgV45HABZSOv7q_EGQ5yaUHll32vcfCS5LPGb7MCKNXSju1u5zdpSRLMSHZm-Q8o3mZ5pzgt8e8SCue07Pkg_c7jEmFWfU-OaM5xQxX1XnybwVGdujbwbeDUUFbg6RHEi0dNFoF65Bt0bqzf9PbGK5-2nQFbczQcgvG9nFFgmnQot9LHTlovUFreIiNgFbgbTccNa_bAA4twakhSAN28GhmnTXSHdDCxN5jJIxAbaJCetPBozzWPw5WSdfoOOPCtNJNI_7WYRtrHcbzzdbZvrbdwWs_8v9PmTvZAMIfk3et7Dx8Ou0Xyeb2ZjP7nt7_mi9m1_epyisWUs7bgqqipQoUrnCZK9yURUlp3ZKyLHOe8aJgRY2ZZFmjgJSMctXkDc_rCiS9SL5Osntn_wzgg-i1V9B10-MFYYxRhjmnEYonqHLWewet2Dvdx48RGRajy-LospjdCZKJ0eVI-XJSH-oemhfCs60RMJ8AOx_kA7wApAtadXBS5Gy8IsZX6VfEVjoBhj4BjHrC0w</recordid><startdate>20210924</startdate><enddate>20210924</enddate><creator>Kai, Takahiko</creator><creator>Oka, Satoshi</creator><creator>Hoshino, Katsuomi</creator><creator>Watanabe, Kazunori</creator><creator>Nakamura, Jun</creator><creator>Abe, Makoto</creator><creator>Watanabe, Akinori</creator><general>The Japanese Circulation Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210924</creationdate><title>Renal Dysfunction as a Predictor of Slow-Flow/No-Reflow Phenomenon and Impaired ST Segment Resolution After Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction With Initial Thrombolysis in Myocardial Infarction Grade 0</title><author>Kai, Takahiko ; Oka, Satoshi ; Hoshino, Katsuomi ; Watanabe, Kazunori ; Nakamura, Jun ; Abe, Makoto ; Watanabe, Akinori</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c495t-88f63c6f3cec09074c0d76733bf277748186656b05a51dce27538cd4d84b9ea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Coronary Angiography</topic><topic>Humans</topic><topic>Kidney Diseases</topic><topic>Myocardial Infarction</topic><topic>No reflow</topic><topic>No-Reflow Phenomenon - diagnostic imaging</topic><topic>No-Reflow Phenomenon - etiology</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Renal dysfunction</topic><topic>ST Elevation Myocardial Infarction - diagnostic imaging</topic><topic>ST Elevation Myocardial Infarction - therapy</topic><topic>ST-elevation myocardial infarction (STEMI)</topic><topic>Thrombolytic Therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kai, Takahiko</creatorcontrib><creatorcontrib>Oka, Satoshi</creatorcontrib><creatorcontrib>Hoshino, Katsuomi</creatorcontrib><creatorcontrib>Watanabe, Kazunori</creatorcontrib><creatorcontrib>Nakamura, Jun</creatorcontrib><creatorcontrib>Abe, Makoto</creatorcontrib><creatorcontrib>Watanabe, Akinori</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kai, Takahiko</au><au>Oka, Satoshi</au><au>Hoshino, Katsuomi</au><au>Watanabe, Kazunori</au><au>Nakamura, Jun</au><au>Abe, Makoto</au><au>Watanabe, Akinori</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Renal Dysfunction as a Predictor of Slow-Flow/No-Reflow Phenomenon and Impaired ST Segment Resolution After Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction With Initial Thrombolysis in Myocardial Infarction Grade 0</atitle><jtitle>Circulation Journal</jtitle><addtitle>Circ J</addtitle><date>2021-09-24</date><risdate>2021</risdate><volume>85</volume><issue>10</issue><spage>1770</spage><epage>1778</epage><pages>1770-1778</pages><artnum>CJ-21-0221</artnum><issn>1346-9843</issn><issn>1347-4820</issn><eissn>1347-4820</eissn><abstract>Background:The slow-flow/no-reflow phenomenon and impaired ST segment resolution (STR) following primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) predict unfavorable prognosis and are characterized by obstruction of the coronary microvascular. Several predictors of slow-flow/no-reflow have been revealed, but few studies have investigated predictors of slow-flow/no-reflow and STR exclusively in acute myocardial infarction patients with initial Thrombolysis in Myocardial Infarction (TIMI) Grade 0.Methods and Results:In all, 279 STEMI patients with initial TIMI Grade 0 were enrolled in the study. Slow-flow/no-reflow was defined as TIMI Grade <3 by angiography after PCI, and impaired STR was defined as STR <50% on an electrocardiogram after PCI. Slow-flow/no-reflow was observed in 31 patients. In multivariate analysis, estimated glomerular filtration rate (eGFR; odds ratio [OR] 0.97; P=0.007), a history of cerebrovascular disease (OR 4.65, P=0.007), time to recanalization ≥4 h (OR 2.76, P=0.023), and systolic blood pressure ≤90 mmHg (OR 3.45, P=0.046) were independent predictors of slow-flow/no-reflow. Impaired STR was observed in 102 of 248 patients with TIMI Grade 3. In multivariate analysis, eGFR (OR 0.94, P<0.001) and occlusion of the left anterior descending artery (OR 4.48, P<0.001) were independent predictors of impaired STR; eGFR was the only independent predictor of both slow-flow/no-reflow and impaired STR.Conclusions:Renal dysfunction may be related to coronary microvascular dysfunction and obstruction.</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>34305099</pmid><doi>10.1253/circj.CJ-21-0221</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Coronary Angiography Humans Kidney Diseases Myocardial Infarction No reflow No-Reflow Phenomenon - diagnostic imaging No-Reflow Phenomenon - etiology Percutaneous Coronary Intervention - adverse effects Renal dysfunction ST Elevation Myocardial Infarction - diagnostic imaging ST Elevation Myocardial Infarction - therapy ST-elevation myocardial infarction (STEMI) Thrombolytic Therapy |
| title | Renal Dysfunction as a Predictor of Slow-Flow/No-Reflow Phenomenon and Impaired ST Segment Resolution After Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction With Initial Thrombolysis in Myocardial Infarction Grade 0 |
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