Clinical significance of no-reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous transluminal coronary angioplasty

Morishima, Itsuro; Sone, Toshio; Mokuno, Shinji; Taga, Shin; Shimauchi, Akemi; Oki, Yoshitaka; Kondo, Junichiro; Tsuboi, Hideyuki; Sassa, Hiromi

doi:10.1016/0002-8703(95)90434-4

Cited by 171 publications

(104 citation statements)

References 20 publications

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“…10 Recent studies have shown that angiographic contrast velocity after successful percutaneous coronary intervention (PCI), as defined by the TIMI criteria, predicts poor left ventricular (LV) functional recovery and a higher risk of cardiac mortality. 11,12 Although TIMI flow grading seems to segregate effective from ineffective flow, this analysis is only a qualitative measure that is subject to interoperator bias and interlaboratory variability. 13 Furthermore, because angiographic contrast velocity alone is not sufficient to assess microvascular damage, refinements in the quantification of the degree of microvascular injury have led to improvements in the prognostic value of this measurement.…”

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confidence: 99%

Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction

et al. 2002

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Background— Recently, it was reported that the degree of microvascular injury and left ventricular functional recovery during the chronic period can be predicted after treatment of the infarct-related artery based on the coronary flow velocity (CFV) pattern assessed using a Doppler guidewire. The aim of this prospective study was to examine whether the CFV pattern may predict complications and in-hospital survival after acute myocardial infarction (AMI). Methods and Results— The study population consisted of 169 consecutive patients with a first anterior AMI successfully treated with percutaneous coronary intervention (PCI). We examined the CFV pattern immediately after PCI using a Doppler guidewire. In accordance with previous findings, we defined severe microvascular injury as a diastolic deceleration time ≤600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without severe microvascular injury (n=118; group 1) and those with severe microvascular injury (n=51; group 2). All of the patients who had cardiac rupture were in group 2. Congestive heart failure (CHF) was observed more frequently in group 2 than in group 1 (53% versus 8%, P <0.001). The in-hospital cardiac mortality rate was significantly higher in group 2 than in group 1 (18% versus 0%, P <0.001). Nine patients in group 2 died, 5 patients because of CHF and 4 patients because of cardiac rupture. Conclusions— These findings suggest that the CFV pattern is an accurate predictor of the presence or absence of complications and of in-hospital survival after AMI.

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confidence: 99%

Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction

et al. 2002

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“…12,16) The rate of arrhythmia, congestive heart failure, and cardiac death is higher in patients with no-reflow during AMI compared to those without. 3,12,13) In addition, other well known risk factors such as increased age, Killip class at admission, low ejection fraction, 12) and angiographic no-reflow phenomenon are other predictors of morbidity and mortality. 12) Pathophysiologic no-reflow is defined as decreased tissue blood flow despite an open infarct related artery.…”

Section: Discussionmentioning

confidence: 99%

“…4) There is a high correlation between no-reflow occurring after AMI and cardiac morbidity and mortality. 3,12) In this case report we present the beneficial effects of administration of verapamil via a perfusion catheter to the distal portion of the artery instead of the coronary ostium in a no-reflow phenomenon in the setting of an AMI.…”

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confidence: 97%

Treatment of No-Reflow Phenomenon with Verapamil after Primary Stent Deployment during Myocardial Infarction.

et al. 2002

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SUMMARYNo-reflow phenomenon is the absence of myocardial perfusion despite adequate dilatation of the infarct related coronary artery during percutaneous coronary intervention. It predicts severe left ventricular dysfunction and poor prognosis in acute myocardial infarction (AMI). The present case is a 54 year old Turkish female who presented with chest pain that had started 2.5 hours earlier. The clinical and laboratory findings were consistent with AMI and the coronary angiogram performed for primary angioplasty revealed a 95% thrombotic occlusion with a TIMI grade I flow in the left anterior descending (LAD) coronary artery. A TIMI grade III flow was achieved with direct stent deployment. However, after the placement of a second stent for severe ostial stenosis more proximally and adjacent to the first one, the antegrade flow became TIMI grade O. As the intracoronary medications did not improve the flow, a mechanical occlusion was considered and a third stent was deployed covering the first two stents. A control angiogram revealed the persistence of TIMI grade O flow. A severe and persistent vasospasm was considered at this point and accordingly, intracoronary verapamil was administered in high concentrations by an infusion catheter to the distal LAD which was followed by the immediate achievement of TIMI grade III flow. Intracoronary administration of high dose verapamil can be performed to prevent vasospasm in resistant no-reflow cases with no evidence of mechanic occlusion. ( and is known to prevent ischaemic myocardial dysfunction.2) However, some studies have showed the absence of expected functional recovery in the left ventricle, despite normal flow in the epicardial coronary artery.3) The 'no-reflow' phenomenon is the absence of myocardial perfusion, despite adequate dilatation of the responsible artery, without a dissection, mechanic obstruction, or distal emboli. 4,5) The 'no-reflow' phenomenon can be detected by angiography, 3) scinFrom

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“…Coronary slow-reflow or no-reflow is diagnosed when TIMI flow grades of 1 or 2, high TIMI frame count, or abnormal myocardial blush is observed immediately post PCI [2]. The phenomenon occurs in approximately 30% of patients receiving PCI for acute myocardial infarction [4,5]. The proposed etiology of coronary no-reflow phenomenon is multifactorial and includes distal embolization of thrombus fragments during PCI, inflammation of the endothelium leading to microvascular dysfunction, reperfusion injury, and vasospasm [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Impervious Coronary No-Reflow: A Case Study

Karimianpour¹,

Maran²

2017

Cardiovasc Pharm Open Access

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Coronary no-reflow phenomenon is a disorder of the microvasculature that results in poor myocardial perfusion in patients with acute myocardial infarction receiving percutaneous coronary intervention. It typically manifests as TIMI 1-2 flow, high TIMI frame counts, and abnormal myocardial blush. The etiology of this condition is multifactorial and so is its treatment. It is encountered in approximately one-third of patients and is therefore of clinical relevance. In this case report, we describe a patient scenario with this condition in which the standard therapy was provided but failed to achieve normal perfusion despite repeat attempts. We also discuss different pharmacological therapies that compose the standard therapy and other adjunctive remedies that have been proven to be beneficial.

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Clinical significance of no-reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous transluminal coronary angioplasty

Cited by 171 publications

References 20 publications

Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction

Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention as a Predictor of Complications and In-Hospital Survival After Acute Myocardial Infarction

Treatment of No-Reflow Phenomenon with Verapamil after Primary Stent Deployment during Myocardial Infarction.

Impervious Coronary No-Reflow: A Case Study

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