Restricted accessResearch articleFirst published online 2015-8
Mild to Moderate Renal Impairment Is Associated With No-Reflow Phenomenon After Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction
We investigated whether admission estimated glomerular filtration rate (eGFR) values are associated with no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Patients (n = 673; 59 ± 13 years; 77.1% men) were stratified into 3 groups according to eGFR at admission: normal renal function (eGFR ≥ 90 mL/min/1.73 m2), mild renal impairment (eGFR 60-89 mL/min/1.73 m2), and moderate renal impairment (eGFR 30-59 mL/min/1.73 m2). No-reflow phenomenon was defined as thrombolysis in myocardial infarction flow grade <3 after pPCI. The rate of no-reflow gradually increased from the normal renal function group to the moderate impaired renal function group (P < .001). Multivariate analysis showed that eGFR (odds ratio [OR] 0.942, P < .001), Killip ≥2 class (OR 3.968, P = .008), left ventricular ejection fraction (OR 0.959, P = .034), and early patency of infarct vessel (OR 0.186, P < .001) were independent predictors of no-reflow phenomenon. Mild to moderate renal impairment at admission is independently associated with no-reflow phenomenon after pPCI.
GrinesCLBrowneKFMarcoJ. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. The primary angioplasty in myocardial infarction study group. N Engl J Med. 1993;328
(10):673–679.
2.
StoneGWPetersonMALanskyAJDangasGMehranRLeonMB. Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction. J Am Coll Cardiol. 2002;39
(4):591–597.
3.
MorishimaISoneTOkumuraK. Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol. 2000;36
(4):1202–1209.
GürMTürkoğluCTaşkınA. Paraoxonase-1 activity and oxidative stress in patients with anterior ST elevation myocardial infarction undergoing primary percutaneous coronary intervention with and without no-reflow. Atherosclerosis. 2014;234
(2):415–420.
8.
GalassoGSchiekoferSD’AnnaC. No-reflow phenomenon: pathophysiology, diagnosis, prevention, and treatment. A review of the current literature and future perspectives. Angiology. 2014;65
(3):180–189.
9.
SmithGLMasoudiFAShlipakMGKrumholzHMParikhCR. Renal impairment predicts long-term mortality risk after acute myocardial infarction. J Am Soc Nephrol. 2008;19
(1):141–150.
10.
CampbellNGVaragunamMSawhneyV. Mild chronic kidney disease is an independent predictor of long-term mortality after emergency angiography and primary percutaneous intervention in patients with ST-elevation myocardial infarction. Heart. 2012;98
(1):42–47.
11.
AkkayaEAyhanEUyarelH. The impact of chronic kidney disease on in-hospital clinical outcomes in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction. Turk Kardiyol Dern Ars. 2011;39
(4):276–282.
12.
AnavekarNSMcMurrayJJVelazquezEJ. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004;351
(13):1285–1295.
13.
AnnukMSoveriIZilmerMLindLHultheJFellströmB. Endothelial function, CRP and oxidative stress in chronic kidney disease. J Nephrol. 2005;18
(6):721–726.
14.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39
(2 suppl 1):S1–S266.
15.
LeveyASBoschJPLewisJBGreeneTRogersNRothD. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med. 1999;130
(6):461–470.
16.
Thrombolysis In Myocardial Infarction (TIMI) trial, phase I findings: TIMI study groups. N Engl J Med. 1985;312
(14):932–936.
17.
HongSNAhnYHwangSH. Usefulness of preprocedural N-terminal pro-brain natriuretic peptide in predicting angiographic no-reflow phenomenon during stent implantation in patients with ST-segment elevation acute myocardial infarction. Am J Cardiol. 2007;100
(4):631–614.
18.
ItoH. No-reflow phenomenon and prognosis in patients with acute myocardial infarction. Nat Clin Pract Cardiovasc Med. 2006;3
(9):499–506.
19.
MancietLHPooleDCMcDonaghPFCopelandJGMathieu-CostelloO. Microvascular compression during myocardial ischemia: mechanistic basis for no-reflow phenomenon. Am J Physiol. 1994;266
(4 pt 2):1541–1550.
20.
SimesRJTopolEJHolmesDRJr. Link between the angiographic substudy and mortality outcomes in a large randomized trial of myocardial reperfusion. Importance of early and complete infarct artery reperfusion. GUSTO-I Investigators. Circulation. 1995;91
(7):1923–1938.
21.
NdrepepaGTirochKFusaroM. 5-year prognostic value of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction. J Am Coll Cardiol. 2010;55
(21):2383–2389.
22.
NerpinEIngelssonERisérusU. Association between glomerular filtration rate and endothelial function in an elderly community cohort. Atherosclerosis. 2012;224
(1):242–246.
23.
StamFvan GuldenerCBeckerA. Endothelial dysfunction contributes to renal function-associated cardiovascular mortality in a population with mild renal insufficiency: the Hoorn study. J Am Soc Nephrol. 2006;17
(2):537–545.
24.
KielsteinJTBögerRHBode-BögerSM. Asymmetric dimethylarginine plasma concentrations differ in patients with end-stage renal disease: relationship to treatment method and atherosclerotic disease. J Am Soc Nephrol. 1999;10
(3):594–600.
25.
AstrupASTarnowLPietraszekL. Markers of endothelial dysfunction and inflammation in type 1 diabetic patients with or without diabetic nephropathy followed for 10 years: association with mortality and decline of glomerular filtration rate. Diabetes Care. 2008;31
(6):1170–1176.
26.
SenNOzluMFAkgulEO. Elevated plasma asymmetric dimethylarginine level in acute myocardial infarction patients as a predictor of poor prognosis and angiographic impaired reperfusion. Atherosclerosis. 2011;219
(1):304–310.
27.
KaysenGA. Inflammation: cause of vascular disease and malnutrition in dialysis patients. Semin Nephrol. 2004;24
(5):431–436.
28.
CelikTIyisoyAYukselUCJataBOzkanM. The impact of admission C-reactive protein levels on the development of no-reflow phenomenon after primary PCI in patients with acute myocardial infarction: the role of inflammation. Int J Cardiol. 2009;136
(1):86–88.
29.
OduncuVTanalpACErkolA. Impact of chronic pre-treatment of statins on the level of systemic inflammation and myocardial perfusion in patients undergoing primary angioplasty. Am J Cardiol. 2011;107
(2):179–185.
30.
SoyluKYukselSGulelO. The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention. J Thorac Dis. 2013;5
(3):258–264.
31.
McCulloughPA. Why is chronic kidney disease the “spoiler” for cardiovascular outcomes?J Am Coll Cardiol. 2003;41
(5):725–728.
32.
FiliopoulosVVlassopoulosD. Inflammatory syndrome in chronic kidney disease: pathogenesis and influence on outcomes. Inflamm Allergy Drug Targets. 2009;8
(5):369–382.
33.
CottoneSLoritoMCRiccobeneR. Oxidative stress, inflammation and cardiovascular disease in chronic renal failure. J Nephrol. 2008;21
(2):175–179.
34.
ShahSVBaligaRRajapurkarMFonsecaVA. Oxidants in chronic kidney disease. J Am Soc Nephrol. 2007;18
(1):16–28.
35.
LandrayMJWheelerDCLipGY. Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: the chronic renal impairment in Birmingham (CRIB) study. Am J Kidney Dis. 2004;43
(2):244–253.
36.
CharronTJaffeRSegevA. Effects of distal embolization on the timing of platelet and inflammatory cell activation in interventional coronary no-reflow. Thromb Res. 2010;126
(1):50–55.
37.
MikhailidisDPAthyrosVG. Acute kidney injury: short-term statin therapy for prevention of contrast-induced AKI. Nat Rev Nephrol. 2014;10
(1):8–9.
38.
AuTHBrucknerAMohiuddinSMHillemanDE. The prevention of contrast-induced nephropathy [published online July 3, 2014]. Ann Pharmacother. 2014.
39.
AbeMMorimotoTAkaoM. Relation of contrast-induced nephropathy to long-term mortality after percutaneous coronary intervention. Am J Cardiol. 2014;114
(3):362–368.
40.
GandhiSMoslehWAbdel-QadirHFarkouhME. Statins and contrast-induced acute kidney injury with coronary angiography: systematic review and meta-analysis [published online May 19, 2014]. Am J Med. 2014.
