No-reflow phenomenon and treatment during percutaneous coronary intervention

doi:10.3969/j.issn.1002-1949.2001.04.009

Abstract：Objective Evaluating the effect of platelet glycoprotein Ⅱb/Ⅲareceptor inhibitor abciximab(ReoPro)on clinical of patients with no-reflow phenomenon which failed to respond to intracoronary nitroglycerin.Method We respectively studied in-hospital clinical outcome and the incidence of in-hospital cardiac events(death,myocardial infarction,revascularisation)of patients with or without no-reflow phenomenon.Result In 1 093 patients undergoing percutaneous coronary revascularisation(percutaneous transluminal coronary angioplasty-PTCA 352 cases,stenting 741 cases),transient or sustained no-reflow was described by operators in 23 patients.In 17 patients,TIMI flow grade Ⅲ was recovered quickly in catheter lab after intracoronary nitroglycerin was administrated.In the other 6 patients who failed to respond to intracoronary nitroglycerin administration,ReoPro was given intravenously;TIMI flow grade Ⅲ and grade Ⅱ were achieved in 3 patients respectively in the catheter lab(P＜0.002);Q-wave and non Q-wave myocardial infarction(QMI and Non-QMI) occurred in 1 patient and 3 patients respectively;There was no difference on in-hospital death and revascularisation between patients with or without no-reflow phenomenon (P＞0.75),but the incidence of myocardial infarction of the patients with no-reflow phenomenon was significantly higher(QMI:16.7% vs 0.37%,P＜0.005;Non-QMI:50% vs 1.05%,P＜0.005).Conclusion No-reflow phenomenon which failed to respond to intracoronary nitroglycerin generally responded promptly to intravenous ReoPro administration with recovery to TIMI grade Ⅱ or Ⅲflow in the catheter lab;In-hospital death and subsequent revascularisation of patients with no-reflow phenomenon were similar to patients without no-reflow phenomenon.This suggests abciximab (ReoPro) is an effective adjunctive therapy for the no-reflow phenomenon, and that platelet mediated microvascular thrombus and embolization may be the mechanism of nitroglycerin-resistant no-reflow phenomenon during percutaneous revascularisation.