Vol. 27 No. 4 (2023)
Endovascular Surgery

Severity scale of coronary microvascular obstruction (no-reflow) during percutaneous coronary interventions in myocardial infarction patients

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  • A.A. Frolov,
  • I.G. Pochinka,
  • I.A. Frolov,
  • K.V. Kuzmichev,
  • A.S. Mukhin,
  • E.G. Sharabrin,
  • V.N. Sinyutin
A.A. Frolov
Privolzhsky Research Medical University, Ministry of Health of Russian Federation, Nizhny Novgorod; City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District, Nizhny Novgorod
Bio
I.G. Pochinka
Privolzhsky Research Medical University, Ministry of Health of Russian Federation, Nizhny Novgorod; City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District, Nizhny Novgorod
I.A. Frolov
City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District, Nizhny Novgorod
K.V. Kuzmichev
Privolzhsky Research Medical University, Ministry of Health of Russian Federation, Nizhny Novgorod; City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District, Nizhny Novgorod
A.S. Mukhin
Privolzhsky Research Medical University, Ministry of Health of Russian Federation, Nizhny Novgorod
E.G. Sharabrin
Privolzhsky Research Medical University, Ministry of Health of Russian Federation, Nizhny Novgorod
V.N. Sinyutin
Aspectus Pharma LLC, Razvilka, Moscow Region
Central illustration
DOI: https://doi.org/10.21688/1681-3472-2023-4-52-63

Published 2023-12-26

Keywords

  • Cohort Studies,
  • Coronary Occlusion,
  • Myocardial Infarction,
  • No-Reflow Phenomenon,
  • Percutaneous Coronary Intervention

How to Cite

Frolov, A., Pochinka, I., Frolov, I., Kuzmichev, K., Mukhin, A., Sharabrin, E., & Sinyutin, V. (2023). Severity scale of coronary microvascular obstruction (no-reflow) during percutaneous coronary interventions in myocardial infarction patients. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 27(4), 52–63. https://doi.org/10.21688/1681-3472-2023-4-52-63

Copyright (c) 2023 Frolov A.A., Pochinka I.G., Frolov I.A., Kuzmichev K.V., Mukhin A.S., Sharabrin E.G., Sinyutin V.N.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Introduction: There is no scale that combines the traditional criteria of coronary microvascular obstruction (CMVO, no-reflow phenomenon) to effectively assess the severity and prognosis of this complication.
Objective: To develop and evaluate the severity scale of CMVO during percutaneous coronary intervention (PCI) for myocardial infarction (MI).
Methods: The cohort study included 203 patients diagnosed with type 1 MI and CMVO during PCI. The CMVO criterion was TIMI flow grade (TFG) <3 points. Using the proposed "CMVO Severity Scale" (CMVO-SS), three groups of patients were identified. CMVO grade 1 (mild): TFG 2 points, Myocardial blush grade (MBG) 2–3 points, ST segment resolution after PCI (rST) >70%. CMVO grade 2 (moderate): TFG 2 points, MBG 0–1 points or rST <70%. CMVO grade 3 (severe): TFG 0-1 points.
Results: Distribution of groups with CMVO of the 1st, 2nd, and 3rd grade is 65 (32%) / 88 (43%) / 50 (25%) patients, respectively. Outcomes by group: acute heart failure grade 3–4 — 2 (3%) / 11 (13%) / 14 (28%), P < .001; ejection fraction — 48 [44; 53] % / 46 [40; 50] % / 42 [39; 49] %, P = .004; in-hospital death — 1 (1.5%) / 12 (13.6%) / 16 (32.0%), P < .001; two-year death — 8 (12.3%) / 19 (21.6%) / 22 (44.0%), P < .001. The multivariate analysis revealed a two-year death odds ratio for the CMVO-SS of 2.40 [95% CI 1.23–5.17], P = .009. Two-year survival probability with CMVO-SS grade 1 was 87.7%, grade 2 — 78.4%, grade 3 — 56.0% (P < .001).
Conclusion: The proposed CMVO severity scale is associated with adverse in-hospital outcomes and two-year mortality.

Received 15 May 2023. Revised 27 September 2023. Accepted 24 October 2023.

Funding: The study was supported by the "Priority 2030" program.

Conflict of interest: The authors declare no conflict of interest.

Contribution of the authors
Conception and study design: A.A. Frolov, E.G. Sharabrin, I.G. Pochinka
Data collection and analysis: A.A. Frolov, I.A. Frolov, K.V. Kuzmichev
Statistical analysis: A.A. Frolov, I.A. Frolov, K.V. Kuzmichev
Drafting the article: A.A. Frolov, I.G. Pochinka, I.A. Frolov
Critical revision of the article: I.G. Pochinka, A.S. Mukhin, E.G. Sharabrin, V.N. Sinyutin
Final approval of the version to be published: A.A. Frolov, I.G. Pochinka, I.A. Frolov, K.V. Kuzmichev, A.S. Mukhin, E.G. Sharabrin, V.N. Sinyutin

pdf (Русский)

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