Long‐Term Prognostic Value of Angiographic No‐Reflow Phenomenon in Patients With Non‐ST‐Segment Elevation Myocardial Infarction

ABSTRACT Background The Global Registry of Acute Coronary Events (GRACE) score has proven value in predicting short‐term prognosis in non‐ST‐elevation myocardial infarction (NSTEMI), but it has only moderate discrimination for long‐term prognosis. The predictive value of the angiographic no‐reflow phenomenon for long‐term outcomes in NSTEMI patients and its incremental contribution to the GRACE score remain unclear. Hypothesis This study aimed to determine: (1) the prognostic value of the angiographic no‐reflow for long‐term mortality in NSTEMI and (2) its additive value over the GRACE risk score. Methods This single‐center cohort study retrospectively recruited consecutive patients with NSTEMI to further determine whether no‐reflow occurred after PCI and conducted follow‐up assessments. The primary endpoint was 3‐year All‐cause mortality. Results A total of 1271 patients were included. No‐reflow occurred in 423 patients (33.3%) and was absent in 848 (66.7%). Deaths were recorded in 114 patients (9.1%). Multivariate Cox regression and three propensity score methods were used to adjust for traditional cardiovascular risk factors. Before PSM, angiographic no‐reflow was associated with increased risks of all‐cause mortality (Hazards Ratio [HR]: 2.52; 95% CI: 1.70–3.74; p < 0.01) and cardiac death (HR: 4.38; 95% CI: 2.92–11.82; p = 0.019). After PSM, similar associations were observed for all‐cause mortality (HR: 2.79; 95% CI: 1.73–7.50; p < 0.001) and cardiac death (HR: 3.03; 95% CI: 1.55–5.95; p = 0.008). When no‐reflow was added to the GRACE score, it conferred significant discrimination and reclassification value for all‐cause mortality (Delta AUC: 0.105; 95% CI: 0.050−0.169; p = 0.005; and net reclassification improvement [NRI] = 0.220) and cardiac death (Delta AUC: 0.098; 95% CI: 0.035−0.163; p = 0.007 and NRI = 0.292). Conclusion The angiographic no‐reflow phenomenon strongly predicts long‐term prognosis after NSTEMI; additionally, the angiographic no‐reflow phenomenon has demonstrated significant discriminatory and reclassification power in the GRACE score.