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Primary percutaneous coronary intervention (pPCI) is currently the most effective treatment strategy in ST-segment elevation acute myocardial infarction (STEMI). A considerable number of patients, however, develop no-reflow phenomenon during pPCI. Compared to similar patients with adequate reflow, those with the no-reflow phenomenon have a higher incidence of death, myocardial infarction and heart failure. We have established a risk prediction model of no-reflow in our previous studies, through which we were able to find out patients at high risk of no-reflow.
A total of 1217 patients were admitted to our hospital during the enrolment for AMI; Patients with high risk of no-reflow (no-flow score ≥ 10, by using a no-flow risk prediction model) were randomly divided into control group and combination therapy group. Patients in control group received conventional treatment, while patients in combination therapy group received high-dose (80mg) atorvastatin pre-treatment, intracoronary administration of adenosine (140μg/min/kg) during PCI procedure, platelet membrane glycoprotein IIb/IIIa receptor antagonist (tirofiban, 10μg/kg bolus followed by 0.15μg/kg/min) and thrombus aspiration. Myocardial contrast echocardiography (MCE) was performed to assess the myocardial perfusion 72 hours after PCI. Major adverse cardiac events (MACE) were followed up for six months.
A total of 621 patients were enrolled, among which 216(34.8%) high risk patients of no-reflow were selected by no-reflow risk prediction model. Patient demographics, angiography and procedural data examined in different group had no significantly different. No-reflow occurred in 11 cases (11/405, 2.7%) in low risk patients, 38 cases (38/108, 35.2%) in control group and 3 cases (2.8%) in combination therapy group. MCE at 72 hours after PCI procedure suggested a higher A × β value in combination therapy group than that of control group (Figure 3, 4). Six months clinical follow-up was obtained in 552 patients. Events rates are presented in Table 3. There were 6(6.3%) events (1 death, 2 non-fatal MIs and 3 revascularizations) in combination therapy group, significantly lower than 12(13.2%) events (4 deaths, 3 non-fatal MIs and 5 revascularizations) in control group.
Our study discovered that using no-flow risk prediction model to screen AMI patients who had been suffered with high risk of no-reflow, and pre-treated them with combination treatment could significantly lower the incidence of no-reflow, and further improved the prognosis.