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

Figures & data

Figure 1 Study profile.

Abbreviations: PCI, percutaneous coronary intervention; CSF, coronary slow-flow.

Table 1 Clinical Characteristics of the Study Population

Variable	CSF/NRP Group (n=89)	Non- CSF/NRP Group (n=463)	Pvalue
Age(years)	64.5±7.9	65.2±8.1	0.854
Sex (female), n(%)	39(43.8%)	204(44.1%)	1
Body mass index (kg/m^2)	22.8±3.5	23.1±3.7	0.628
Diabetes mellitus, n(%)	48(53.9%)	168(36.3%)	0.002
Hypertension, n(%)	45(50.6%)	172(37.1%)	0.018
Current smoker, n(%)	32(36.0%)	142(30.7%)	0.383
Previous MI, n(%)	41(46.1%)	212(45.8%)	1
Previous ischemic CVA, n(%)	9(10.1%)	41(8.9%)	0.840
LVEF(%)	40.8±6.2	40.2±6.4	0.328
NYHA 2–3 on admission, n(%)	62(69.7%)	362(78.2%)	0.099
eGFR, mL/min/1.73 mm^2	60.5±22.8	61.1±23.6	0.462
ACEIs/ARBs, n(%)	42(47.2%)	231(49.9%)	0.646
Beta-blockers, n(%)	40(44.9%)	229(49.5%)	0.488
Statin, n(%)	86(96.6%)	454(98.1%)	0.421
PPI, n(%)	84(94.4%)	449(97.0%)	0.210
WBC count (10^9/L)	6.8±1.9	6.7±1.7	0.764
MPV(fL)	10.1±0.8	10.4±0.9	0.195
Neutrophil ratio (%)	55.6±19.4	52.4±18.3	0.038
PDW (%)	11.9±1.8	11.2±1.5	0.214
HDL-C (mmol/L)	1.2±0.4	1.1±0.3	0.29
LDL-C (mmol/L)	3.0±0.8	2.8±0.6	0.029
TG (mmol/L)	1.6±0.9	1.5±0.8	0.682
TC (mmol/L)	4.6±0.9	4.4±0.8	0.692
FG (mmol/L)	8.3± 1.3	6.8±1.1	0.005
Creatinine (mg/dL)	58.4±11.9	57.9±11.6	0.328
UA (mmol/L)	332.6±82.9	308.2±62.8	0.045
Hs-CRP (mmol/L)	9.8±4.8	7.3±3.9	0.037

Note: Bold values are statistically significant (p< 0.05).

Abbreviations: MI, myocardial infarction; CVA, cerebrovascular accident; GI, gastrointestinal; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; eGFR, estimated glomerular filtration rate; ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers; PPI, proton pump inhibitor; MPV,mean platelet volume; PDW, platelet distribution width; HDL, high-density lipoprotein; LDL, low-density lipoprotein; TG, triglyceride; TC, total cholesterol; FG, fasting glucose; UA, uric acid; Hs-CRP,high-sensitivity C-reactive protein.

Table 2 Procedure-Related Characteristics of the Studied Patients

Variables	CSF/NRP Group (n=89)	Non- CSF/NRP Group (n=463)	Pvalue
Procedural access
Radial	32(36.0%)	146(31.5%)	0.242
Femoral	22(24.7%)	118(25.5%)	0.896
Radial and femoral	35(39.3%)	199(43.0%)	0.559
Total amount of contrast(mL)	245.8±123.6	239.4±119.7	0.681
Total time of procedure (min)	118.4±56.7	116.5±55.8	0.395
LAD occlusion, n (%)	23(25.8%)	126(27.2%)	0.797
LCX occlusion, n (%)	22(24.7%)	118(25.5%)	0.896
RCA occlusion, n (%)	47(52.8%)	225(48.6%)	0.489
Occlusion lesion length, mm	56.8±24.7	57.4±23.6	0.628
Retrograde filling > grade 2	31(34.8%)	218(47.1%)	0.036
Reverse wire technique	38(42.7%)	186(40.2%)	0.724
IABP, n(%)	6(6.7%)	36(7.8%)	0.813
IVUS, n(%)	17(19.1%)	102(22.0%)	0.577
Number of stents per patient	2.6±1.8	2.7±1.9	0.684
Stent length (mean, mm)	62.8±22.5	63.4±24.3	0.892
Glycoprotein IIb/IIIa receptor inhibitor, n(%)	42(47.2%)	252(54.4%)	0.246
LMWH (%)	29(32.6%)	135(29.2%)	0.528

Abbreviations: LAD, left anterior descending artery; LCX, left circumflex coronary artery; RCA, right coronary artery; IABP, intra-aortic balloon pump; IVUS, intravascular ultrasonography; TIMI, thrombolysis in myocardial infarction; LMWH, low-molecular-weight heparin.

Table 3 Univariate and Stepwise Multivariate Logistic Regression Analysis of Risk Factors of CSF/NRP

	Univariate Analysis			Multivariate Analysis
	OR	95% CI	P value	OR	95% CI	P value
Age	1.000	0.729–1.213	0.782	–	–	–
Female sex	0.892	0.658–1.869	0.692	–	–	–
Current smoking	1.124	0.732–1.685	0.358	–	–	–
Body mass index	1.097	0.912–2.289	0.529	–	–	–
Diabetes mellitus	1.895	1.271–2.826	0.035	1.962	1.198–2.721	0.042
Hypertension	1.684	1.118–1.959	0.029	1.375	1.122–1.899	0.182
PDW	1.321	1.09–1.59	0.029	1.204	1.181–1.688	0.089
Neutrophil ratio	1.294	1.112–1.985	0.034	1.182	1.091–1.979	0.132
MPV	1.307	1.092–1.995	0.026	1.284	1.108–1.895	0.046
LDL-C	1.422	1.166–2.521	0.019	1.383	1.105–2.491	0.036
FG	2.114	1.562–3.095	0.028	2.095	1.495–2.899	0.018
UA	1.186	0.897–1.568	0.624	–	–	–
Hs-CRP	2.323	1.629–3.592	0.012	2.218	1.556–3.519	0.029
Retrograde filling > grade 2	0.782	0.556–0.925	0.025	0.822	0.622–0.907	0.037
GPI	1.195	0.893–1.688	0.329	–	–	–

Note: Bold values are statistically significant (p< 0.05).

Abbreviations: MPV, mean platelet volume; PDW, platelet distribution width; LDL, low-density lipoprotein; FG, fasting glucose; UA, uric acid; Hs-CRP, high-sensitivity C-reactive protein; GPI,glycoprotein IIb/IIIa receptor inhibitor.

Table 4 MACCE During Hospital Stay and at 12-Monthfollow-Up

Variable	CSF/NRP Group (n=89)	Non- CSF/NRP Group (n=463)	Pvalue
MACCE during hospitalization
Cardiogenic death, n(%)	1(1.1%)	4(0.9%)	1
AMI, n(%)	1(1.1%)	6(1.3%)	1
PCI-relatedMI, n(%)	29(32.6%)	69(14.9%)	<0.001
Stent thrombosis, n(%)	1(1.1%)	7(1.5%)	1
Stroke, n(%)	0	2(0.4%)	1
TVR, n(%)	3(3.4%)	13(2.8%)	0.731
Overall MACCE, n(%)	33(37.1%)	86(18.6%)	<0.001
MACCE at12-month follow-up
Cardiogenic death, n(%)	1(1.1%)	6(1.3%)	1
AMI, n(%)	2(2.2%)	16(3.5%)	0.751
Stent thrombosis, n(%)	6(6.7%)	22(4.8%)	0.430
Stroke, n(%)	1(1.1%)	3(0.6%)	0.506
TVR, n(%)	11(22.0%)	27(5.8%)	<0.001
Overall MACCE, n(%)	42(47.2%)	99(21.4%)	<0.001

Note: Bold values are statistically significant (p< 0.05).

Abbreviations: MACCE, major adverse cardiac and cerebral events; PCI, percutaneous coronary intervention; TVR, target vessel revascularization; AMI, acute myocardial infarction.

Figure 2 Cumulative MACCE-free survival.