The impact of kidney function on the slow-flow/no-reflow phenomenon in patients treated with primary percutaneous coronary intervention: registry analysis

Abstract Funding Acknowledgements Type of funding sources: None. Objective To analyze the impact of declining kidney function on the occurrence of the slow-flow/no-reflow phenomenon, in patients with ST elevation myocardial infarction (STEM) who had been treated with primary PCI (pPCI), and to analyze the prognostic impact of the slow-flow/no-reflow phenomenon on short- and long-term mortality in these patients. Methods We analyzed 3,115 consecutive patients. A value of estimation of the glomerular filtration rate (eGFR) at admission eGFR<90ml/min/m2 was considered to be a reduced baseline eGFR. The follow-up period was 8 years. Results The slow-flow/no-reflow phenomenon through the IRA was registered in 146 (4.7%) patients. Stimated GFR<90ml/min/m2 was an independent predictor for the occurrence of slow-flow/no-reflow phenomenon (OR2.91, 95%CI 1.25-3.95, p<0.001), and the risk for the occurrence of the slow-flow/no-reflow phenomenon increased with the decline of the kidney function: eGFR 60-89 ml/min/m2: OR1.94 (95%C 1.22-3.07, p=0.005), eGFR 45-59ml/min/m2: OR 2.55(95%CI 1.55-4.94, p<0.001), eGFR 30-44 ml/min/m2; OR 2.77(95%CI 1.43-5.25, p<0.001), eGFR 15-29 ml/min/m2: OR 5.84 (95%CI 2.84-8.01, p<0.001). In-hospital, 30-day, 1-year, and 8-year mortality were significantly higher in patients with the slow-flow/no-reflow phenomenon, as compared to patients with TIMI flow grade 3 – in-hospital mortality of 30.1% vs 2.9%, respectively, p<0.001; 30-day mortality: 31.5% vs 3.2%, respectively, p<0.001; 8-year mortality: 38.1% vs 6.9%, respectively, p<0.001 (Figure 1). The slow-flow/no-reflow phenomenon was a strong independent predictor of short-and long-term all-cause mortality: 30-day mortality (HR 2.62, 95%CI 1.78-3.57, p<0.001), 8-year mortality (HR 2.09, 95%CI 1.49-2.09, p<0.001). Conclusion Reduced baseline kidney function was an independent predictor for the occurrence of the slow-flow/no-reflow phenomenon, and its prognostic impact started with the mildest decrease of eGFR (below 90ml/min/m2), and increased with its further decline. The slow-flow/no-reflow phenomenon was a strong independent predictor for mortality in the short- and long-term follow-up of the analyzed patients.