Incidence, Predictors, and Prognosis of Coronary Slow-Flow and No-Reflow Phenomenon in Patients with Chronic Total Occlusion Who Underwent Percutaneous Coronary Intervention

Abstract

Background

The incidence and prognosis of coronary slow-flow (CSF) and no-reflow phenomenon (NRP) in patients with coronary chronic total occlusion (CTO) who underwent percutaneous coronary intervention (PCI) remain unclear.

Methods

This single-center prospective study aimed to investigate the incidence of CSF/NRP during CTO interventional therapy, determine predictors of CSF/NRP, and evaluate its effect on patient outcomes.

Results

In this study, 552 patients with CTO who underwent PCI were included. CSF/NRP occurred in 16.1% of them. They had higher incidences of diabetes mellitus (53.9% vs 36.3%, p=0.002) and hypertension (50.6% vs 37.1%, p=0.018) and a lower incidence of retrograde filling grade >2 (34.8% vs 47.1%, p=0.036). Patients with CSF/NRP had a higher neutrophil ratio (55.6±19.4 vs 52.4±18.3, p=0.038) and levels of low-density lipoprotein (LDL; 3.0±0.8 vs 2.8±0.6, p=0.029), fasting glucose (FG; 8.3±1.3 vs 6.8±1.1, p=0.005), uric acid (332.6±82.9 vs 308.2±62.8, p=0.045), and high-sensitivity C-reactive protein (Hs-CRP; 9.8±4.8 vs 7.3±3.9, p=0.036). A multivariate logistic regression analysis revealed that diabetes mellitus (odds ratio [OR], 1.962; 95% confidence interval [CI]: 1.198–2.721; p=0.042), mean platelet volume (MPV; OR,1.284; 95% CI, 1.108–1.895; p=0.046), LDL cholesterol (LDL-C; OR, 1.383; 95% CI, 1.105–2.491; p=0.036), FG (OR, 2.095; 95% CI, 1.495–2.899; p=0.018), Hs-CRP(OR, 2.218; 95% CI, 1.556–3.519; p=0.029), and retrograde filling of grade >2 (OR, 0.822; 95% CI, 0.622–0.907; p=0.037) were independent predictors of CSF/NRP in CTO patients who underwent PCI. Kaplan-Meier analysis revealed that the patients in the CSF/NRP group had a significantly lower cumulative major cardiac and cerebrovascular events (MACCE)-free survival than those in the non-CSF/NRP group (p<0.0001).

Conclusion

Of the patients with CTO who underwent PCI, 16.1% developed CSF/NRP and had a significantly lower cumulative MACCE-free survival rate. Diabetes mellitus; higher levels of MPV, LDL-C, FG, and Hs-CRP; and a lower incidence of retrograde filling grade >2 were independent predictors of CSF/NRP in CTO patients who underwent PCI. Thus, they can be used for risk stratification.

Keywords:

• coronary slow-flow
• no-reflow phenomenon
• coronary chronic total occlusion
• PCI
• prognosis

Abbreviations

CSF, coronary slow-flow; NRP, no-reflow phenomenon; TIMI, thrombolysis in myocardial infarction; CTO, coronary chronic total occlusion; PCI, percutaneous coronary intervention; MACCE, major adverse cardiac and cerebral events; TVR, target vessel revascularization; GPI, glycoprotein IIb/IIIa inhibitor.

Ethics Approval and Informed Consent

The study had already been approved by Ethics Committee of the People’s Hospital of China Medical University and all subjects provided their informed, written consent before participation.

Data Sharing Statement

The data supporting the results in the current study are available from the corresponding author on reasonable request.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.