The following is a summary of “Coronary no-reflow and adverse events in patients with acute myocardial infarction after percutaneous coronary intervention with current drug-eluting stents and third-generation P2Y12 inhibitors,” published in the November 2023 issue of Cardiology by Ndrepepa et al.
Due to advancements in stent technology and antithrombotic drugs, an updated assessment of the prevalence and prognostic significance of coronary no-reflow (CNCNR and Adverse Events in AMI Patients after PCI with Current DES and Third-generation P2Y12 InhibitorsR) is warranted.
Researchers performed a retrospective study to evaluate the correlation between CNR and adverse outcomes in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) utilizing drug-eluting stents (DES) and newer antithrombotic agents, ticagrelor or prasugrel.
They enrolled 3100 AMI patients who had undergone PCI with contemporary DES and third-gen P2Y12 inhibitors. CNR was characterized as Thrombolysis in Myocardial Infarction (TIMI) blood flow grade ≤ 2 post-PCI. The main outcome was the 1-year occurrence of net adverse clinical and cerebral events, constituting a composite of any-cause mortality, myocardial infarction, stroke, or significant bleeding.
The results showed CNR in 130 individuals (4.2%). In the CNR group, the primary endpoint occurred in 28 patients, while in the reflow group, it occurred in 354 patients (cumulative incidence 23.2% and 12.8%; adjusted hazard ratio = 1.53, 95% CI 1.01–2.33; P=0.049). Patients with CNR demonstrated significantly elevated 1-year incidences of death or myocardial infarction (14.6% vs. 7.6%; P=0.003), myocardial infarction (8.8% vs. 3.9%; P=0.007), and major bleeding (10.9% vs. 5.6%; P=0.008) compared to those with reflow. The highest risk of adverse events in CNR patients occurred in the initial 30 days post-PCI.
Investigators concluded that among AMI patients treated with modern DES and third-generation P2Y12inhibitors, CNR was linked to an increased risk of adverse outcomes at 1 year.