Coronary artery ectasia, an independent predictor of no-reflow after primary PCI for ST-elevation myocardial infarction

• Published in: International journal of cardiology Vol. 265; pp. 12 - 17
• Main Authors: Schram, H.C.F., Hemradj, V.V., Hermanides, R.S., Kedhi, E., Ottervanger, J.P.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.08.2018
• Subjects: Aged; CAE; Case-Control Studies; Cohort Studies; Coronary Vessels - diagnostic imaging; Dilatation, Pathologic - diagnostic imaging; Dilatation, Pathologic - etiology; Female; Humans; Male; Middle Aged; No-reflow; No-Reflow Phenomenon - diagnostic imaging; No-Reflow Phenomenon - etiology; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - trends; Predictive Value of Tests; Primary percutaneous coronary intervention; Prospective Studies; Retrospective Studies; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - surgery; ST-segment elevation myocardial infarction; Thrombus burden; Primary PCI; CAE; PTFE; Thrombus burden; Primary percutaneous coronary intervention; IRV; ACS; RCA; No-reflow; TIMI; PCI; STEMI; ST-segment elevation myocardial infarction; MI; CABG
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2018.04.120

The no-reflow phenomenon is a serious complication after primary percutaneous coronary intervention (PCI) for ST-elevation Myocardial Infarction (STEMI). Coronary artery ectasia (CAE) may increase the risk of no-reflow, however, only limited data is available on the potential impact of CAE. The aim of this study was to determine the potential association between CAE and no-reflow after primary PCI. A case control study was performed based on a prospective cohort of STEMI patients from January 2000 to December 2011. All patients with TIMI 0–1 flow post primary PCI, in the absence of dissection, thrombus, spasm or high-grade residual stenosis, were considered as no-reflow case. Control subjects were two consecutive STEMI patients after each case, with TIMI flow ≥2 after primary PCI. CAE was defined as dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal coronary artery. In the no-reflow group, frequency of CAE was significantly higher (33.8% vs 3.9%, p < 0.001) compared to the control group. Baseline variables were comparable between patients with and without CAE. Patients with CAE had more often TIMI 0–1 flow pre-PCI (91% vs 71% p = 0.03), less often anterior STEMI (3% vs 37%, p < 0.001) and underwent significantly less often a PCI with stenting (47% vs 74%, p = 0.003). After multivariate analysis, CAE remained a strong and independent predictor of no-reflow (OR 13.9, CI 4.7–41.2, p < 0.001). CAE is a strong and independent predictor of no-reflow after primary PCI for STEMI. Future studies should assess optimal treatment. •No reflow is a serious complication of percutaneous coronary intervention in patients with ST-elevation myocardial infarction•One third of patients with no reflow had coronary artery ectasia•Coronary ectasia increases the risk of no reflow in patients treated percutaneously for ST-elevation myocardial infarction