A no-reflow prediction model in patients with ST-elevation acute myocardial infarction and primary drug-eluting stenting.

Objectives: This study was undertaken to assess independent no-reflow predictors in patients with ST-elevation acute myocardial infarction (STEMI) and primary drug-eluting stenting in the current interventional strategies.

Design: One thousand four hundred and thirteen patients with STEMI were successfully treated with primary drug-eluting stenting within 12 h after AMI. All clinical, angiographic and procedural data were collected. Univariate and multivariate logistic regression was used to identify independent no-reflow predictors.

Results: The no-reflow was found in 297 (21%) of 1413 patients. Univariate and multivariate logistic regression identified that age (>65 years, OR 1.47, 95% CI 1.46-1.49; p = 0.007), long time-to-reperfusion (>6 h, OR 1.27, 95% CI 1.16-1.40; p = 0.001), admission plasma glucose (>13.0 mmol/L, OR 1.27, 95% CI 1.16-1.40; p = 0.027), collateral circulation (0-1, OR 1.69, 95% CI 1.25-2.29; p = 0.001), pre-PCI thrombus score (≥4, OR 1.36, 95% CI 1.16-1.79; p = 0.011), and IABP use before PCI (OR 2.89, 95% CI 1.65-5.05; p < 0.0001) were independent no-reflow predictors. The no-reflow rate significantly increased as the number of independent predictors increased (0%, 6%, 15%, 25%, 40%, 50% and 100% in patients with 0, 1, 2, 3, 4, 5, and 6 independent predictors, respectively; p < 0.0001).

Conclusions: The prediction model consisted of six no-reflow predictors in patients with STEMI and primary drug-eluting stenting and should be confirmed in large-scale prospective studies.