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1 - ( ) - ST. :. (No-reflow). ST :.. SPSS. ( / ) :.(P</).. b/a... :. : // : -// : drltfamn@ yahoo.com *

2 / /. (STEMI) ST (WHO) (AHA). ().... (PCI) (STEMI) ST..().() STEMI. TIMI III. -/.(-).() 1 Primary Percutaneous Coronary Intervention 2 No-reflow phenomenon

3 / STEMI ±. T X2 P.. / ).( /. /±/ /±/.(P</) ( ) ( ) ( ) ( ). /±/ /±/.(P</). II b/iii a (EF). TIMI. III -... SPSS (Inc, Chicago, IL SPSS). 3 Predilatation 4 Post dilatation

4 / /. /.(P>/) / (P>/) (P>/) / ±/) /±/ /±/.(P>/ /±/ /.(P</) ±/ ±/.(P</) /.( ) (P</) /.(P</) (LAD) (LCX). (RCA) / / LCX / LAD (SVG) RCA LAD.. / /.(P>/) /.(P>/) / / /.(P>/) IIb/IIIa.

5 / STEMI STEMI : / ± / <0.01 /±/ /±/ () % / % (%) % % (%) % % %) % % (%) /±/ <0.001 % / () (%) <0.01 % % / (%) < / < / % % / (%) % / % / (%) % / % IIb/III a % % (%) % / % / (%)post dilation /±/ mm / ± / mm (mm) / ± / mm <0.01 ±/ / ± / mm (mm) %. (%) ±. (%) <0.001 % % / (%) <0.02 % / % / (%) Non - significant:.() () () () (). /..() (Kloner).()

6 / /.( ).( ) (Zhao) ().() (). () (Lee) (Katsuomi).( )..() /-/ ( ) - ( )..... (Brosh) () (Lee).() (-). ( ).

7 / STEMI. ).( Export.. () (Katsumi) () (Zalewski) () (Brosh) remodeling...(- ).( ) LAD..( ) (Hong) (Brosh).().( ) (Hong)

8 / /.. ) (.. References: 1.Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003; 361: Jacobs AK, Antman EM, Ellrodt G, et al. Recommendation to develop strategies to increase the number of ST-segment-elevation myocardial infarction patients with timely access to primary percutaneous coronary intervention. Circulation 2006; 113: Piana RN, Paik GY, Moscucci M, et al. Incidence and treatment of 'no-reflow' after percutaneous coronary intervention. Circulation 1994; 89: Morishima I, Sone T, Mokuno S, et al. Clinical significance of no-reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous transluminal coronary angioplasty. Am Heart J 1995; 130: Resnic FS, Wainstein M, Michael KY, et al. No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am heart J 2003; 145: Abbo KM, Dooris M, Glazier S, et al. Features and outcome of no-reflow after percutaneous coronary intervention. Am J Cardiol 1995; 75: Patel MR, Dehmer GJ, Hirshfeld JW, et al. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology. Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography. Catheter Cardiovasc Interv 2009; 73: E Kloner RA, Ganote CE, Jennings RB, et al. The "no-reflow" phenomenon after temporary coronary occlusion in the dog. J Clin Invest 1974; 54: Reffelmann T, Kloner RA. Microvascular alterations after temporary coronary artery occlusion: the no-reflow phenomenon. J Cardiovasc Pharmacol Ther 2004; 9: Olafsson B, Forman MB, Puett DW, et al. Reduction of reperfusion injury in the canine preparation by intracoronary adenosine: importance of the endothelium and the noreflow phenomenon. Circulation 1987; 76: Paik GY, Caputo RP, Nunez BD, et al. Thrombus contains solu- ble factors which decrease blood flow in swine coronary arteries through a nitrous oxide-dependent pathway. J Am Coll Cardiol 1994; 23: Lee CH, Wong HB, Tan HC, et al. Impact of reversibility of no reflow phenomenon on 30- day mortality following percutaneous revascularization for acute myocardial

9 / STEMI infarction-insights from a 1,328 patient registry. J Interv Cardiol 2005; 18: Brosh D, Assali AR, Mager A, et al. Effect of No-reflow during Primary percutaneous coronary intervention for acute myocardial infarction on six month mortality. Am J cardiol 2007; 99: Iwakara K, Ito H, kawano S, et al. Chronic pretreatment of statins is associated with the reduction of the No-reflow phenomenon in the patients with reperfused acute myocardial infarction. Europ heart J 2006; 27: Hong SN, Ahn Y, Hwang SH, et al. Usefulness of preprocedural N-terminal probrain natriuretic peptide in predicting angiographic no-reflow phenomenon during stent implantation in patients with STsegment elevation acute myocardial infarction. Am J Cardiol 2007; 100: Tanaka A, Kawarabayashi T, Nishibori Y, et al. No-Reflow Phenomenon and Lesion Morphology in Patients With Acute Myocardial Infarction. Circulation 2002; 105: Zalewski J, Undas A, Godlewski J, et al. Noreflow phenomenon after acute myocardial infarction is associated with reduced clot permeability and susceptibility to lysis. Arterioscler Thromb Vasc Biol 2007; 27: Zhao JL, Yang YJ, Pei WD, et al. The effect of statins on the no-reflow phenomenon: an observational study in patients with hyperglycemia before primary angioplasty. Am J Cardiovasc Drugs 2009; 9: Hong YJ, Jenog MH, Choi YH, et al. Impact of plaque components on No-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology- intravascular ultrasound analysis. Europ Heart J 2009; 10: Matsumoto H, Inone N, Takaoka H, et al. Depletion of antioxidants is associated with No-reflow phenomenon in acute myocardial infarction.clin cardiol 2004; 27: Hahn JY, Song YB, Gwon HC, et al. Relation of left ventricular infarct transmurality and infarct size after primary percutaneous coronary angioplasty to time from symptom onset to balloon inflation. Am J Cardiol 2008; 102: Aquaro GD, Pingitore A, Strata E, et al. Relation of pain-to-balloon time and myocardial infarct size in patients transferred for primary percutaneous coronary intervention. Am J Cardiol 2007; 100: Deluca G, Gibson MC, Haber K, et al. Assoceation between kilip class at presentation and impaired myocardial perfusion among patients with ST-Segment elevation myocardial infarction treated with Primary angioplasty and adjunctive glycoprotein II b/iii b inhibitors. Am Heart J 2009; 158: Iwakura K, Ito H, Kawano S, et al. Predictive factors for development of the no-reflow phenomenon in patients with reperfused anterior wall acute myocardial infarction. J Am Coll Cardiol 2001; 38: