Incidence and Management of "No-Reflow" Following Percutaneous Coronary Interventions

Kelly, Robert V.; Cohen, Mauricio G.; Stouffer, George A.

doi:10.1097/00000441-200502000-00005

Cited by 15 publications

(6 citation statements)

References 51 publications

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“…However, PCI does not always provide good outcome. One of PCI complications often reported is no reflow phenomenon 9 ,10…”

Section: Introductionmentioning

confidence: 99%

“…No reflow phenomenon is defined as a complex condition associated with inadequate myocardial perfusion of the coronary artery without evidence of angiographic epicardial vessel obstruction, spasm, or dissection 9 ,11, 12, 13, 14, 15. No reflow phenomenon is diagnosed based on angiography, myocardial contrast echocardiography (MCE), and cardiac magnetic resonance imaging (CMRI) 4 .…”

Section: Introductionmentioning

confidence: 99%

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The predictors of no reflow phenomenon after percutaneous coronary intervention in patients with ST elevation myocardial infarction: A meta-analysis

Fajar

Heriansyah

Rohman

2018

Indian Heart Journal

102

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ObjectiveTo investigate the no reflow risk factors after percutaneous coronary intervention in ST elevation myocardial infarction patients.MethodSample size, mean ± standard deviation (SD) or frequencies (percent) of normal and no reflow groups were extracted from each study.ResultsOf 27 retrospective and prospective studies, we found that increasing risks of no reflow were associated with advanced age, male, family history of coronary artery disease, smoking, diabetes mellitus, hypertension, delayed reperfusion, killip class ≥2, elevated blood glucose, increased creatinine, elevated creatine kinase (CK), higher heart rate, decreased left ventricular ejection fraction (LVEF), collateral flow ≤1, longer lesion length, multivessel disease, reference luminal diameter, initial thrombolysis in myocardial infarction (TIMI) flow, and high thrombus burden. Moreover, initial TIMI flow ≤1 and high thrombus burden had the greater impact on no reflow (OR95%CI = 3.83 [2.77–5.29], p < 0.0001 and 3.69 [2.39–5.68], p < 0.0001, respectively).ConclusionOur meta-analysis reveals that initial TIMI flow ≤1 and high thrombus burden are the most impacted no reflow risk factors.

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“…However, PCI does not always provide good outcome. One of PCI complications often reported is no reflow phenomenon 9 ,10…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The predictors of no reflow phenomenon after percutaneous coronary intervention in patients with ST elevation myocardial infarction: A meta-analysis

Fajar

Heriansyah

Rohman

2018

Indian Heart Journal

102

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“…7,8 An exceedingly complicated condition known as "slowed/no flow" occurs when the remaining coronary arteries receive insufficient blood flow during PCI despite no obvious angiographical evidence of blockage, spasm, or dissection of the epicardial arteries. [9][10][11] Myocardial contrast echocardiography (MCE) and cardiac magnetic resonance imaging (CT) are the diagnostic tools I use to make this diagnosis (CMRI).Because of its sensitivity and precision, CMRI is widely acknowledged as the most effective method for determining how much no-re-flow is present in a sample. But they are rarely required, as angiograms are sufficient in most cases.…”

Section: Discussionmentioning

confidence: 99%

Rate and Determinants of Slow Flow / No-Reflow in Patients Undergoing Primary Percutaneous Coronary Intervention at Sandaman Provincial Hospital Quetta

Kakar¹,

Kumar²,

Shaikh³

et al. 2022

PJMHS

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Objective: We investigated the rate of slow/no flow during percutaneous coronary intervention, the clinical and angiographical predictor and the immediate hemodynamic role of slow / no flow. Material & Method: The cross-sectional study was done at Sandaman Provincial Hospital, the Loralai Medical Collage Loralai, Bolan University of Medical and Health Sciences Quetta for six months from 1st July, 2021 to 31st December, 2021. We included ST-elevation myocardial infarction patients who got primary percutaneous coronary intervention (PCI). Patient information, including demographic and clinical data was collected. In this study, thrombolysis in myocardial infarction was used to determine the antegrade flow. There was an evaluation of the existence, predictors, and consequences of slow/no flow in the patients. SPSS 21 was used for data analysis. Results: Among the 300 patients, 283 (80.9%) were males. There were 54 (18.0%) patients who had angiographic slow/no flow during the procedure. TIMI grades were 0 in 13 (4.33%), 1 in 16 (5.33%), and 2 in 25 (8.33%) patients in these affected groups in the study. Smoking status was significantly different between slow and no flow (p=0.023). We found significant associations between prior MI, nonappearance of pre-infarction anginal symptoms, and any cerebrovascular disease with slow/no blood flow (p<0.05). The class III or IV Killip score was significantly higher in the slow/low flow group than the normal-flow group (p<0.05). Intracoronary adenosine and epinephrine were the most often used medications for pharmacological therapy of no/slow flow. The hemodynamic instability of two of the patients (3.70%) of the ventricular tachycardia treatment (VT) cases led to their deaths, while the stability of two (3.70%) of the patients’ VTs required pharmaceutical cardioversion. Conclusion: The occurrence of slow/no flow can be predicted with a history and angiographical feature. Keywords: Slow/no flow, Primary PCI, Angiographical predictors, Hemodynamics’.

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“…However, it is essential to note that favorable outcomes are not always guaranteed with primary PCI, as a commonly reported complication is the occurrence of the no-reflow phenomenon. 9,10 The no-reflow phenomenon is defined as a complex condition characterized by insufficient myocardial perfusion in a coronary artery, even in the absence of apparent evidence of angiographic epicardial vessel obstruction, spasm, or dissection. [11][12][13] Diagnosis of the no-reflow phenomenon relies on several diagnostic methods, including angiography, myocardial contrast echocardiography (MCE), and cardiac magnetic resonance imaging (CMRI).…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, Singh 8 proposed that primary PCI is preferable to coronary artery bypass grafting (CABG), despite both procedures yielding similar outcomes in terms of quality of life. However, it is essential to note that favorable outcomes are not always guaranteed with primary PCI, as a commonly reported complication is the occurrence of the no‐reflow phenomenon 9,10 …”

Section: Introductionmentioning

confidence: 99%

The predictive value of laboratory parameters for no‐reflow phenomenon in patients with ST‐elevation myocardial infarction following primary percutaneous coronary intervention: A meta‐analysis

Wang,

Huang,

Zhou

et al. 2024

Clinical Cardiology

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To date, the predictive role of laboratory indicators for the phenomenon of no flow is unclear. Hence, our objective was to conduct a meta‐analysis to investigate the association between laboratory parameters and the risk of the no‐reflow phenomenon in patients with ST‐elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI). This, in turn, aims to offer valuable insights for early clinical prediction of no‐reflow. We searched Pubmed, Embase, and Cochrane Library from the establishment of the database to October 2023. We included case‐control or cohort study that patients with STEMI following primary PCI. We excluded repeated publication, research without full text, incomplete information or inability to conduct data extraction and animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data. The pooled results indicated that elevated white blood cell (WBC) count (odds ratio [OR] = 1.061, 95% confidence interval [CI]: 1.013–1.112), neutrophil count (OR = 1.324, 95% CI: 1.128–1.553), platelet (PLT) (OR = 1.002, 95% CI: 1.000–1.005), blood glucose (OR = 1.005, 95% CI: 1.002–1.009), creatinine (OR = 1.290, 95% CI: 1.070–1.555), total cholesterol (TC) (OR = 1.022, 95% CI: 1.012–1.032), d‐dimer (OR = 1.002, 95% CI: 1.001–1.004), and fibrinogen (OR = 1.010, 95% CI: 1.005–1.015) were significantly associated with increased risk of no‐reflow. However, elevated hemoglobin was significantly associated with decreased risk of no‐reflow. In conclusion, our comprehensive analysis highlights the predictive potential of various parameters in assessing the risk of no‐reflow among STEMI patients undergoing PCI. Specifically, WBC count, neutrophil count, PLT, blood glucose, hemoglobin, creatinine, TC, d‐dimer, and fibrinogen emerged as significant predictors. This refined risk prediction may guide clinical decision‐making, allowing for more targeted and effective preventive measures to mitigate the occurrence of no‐reflow in this patient population.

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Incidence and Management of "No-Reflow" Following Percutaneous Coronary Interventions

Cited by 15 publications

References 51 publications

The predictors of no reflow phenomenon after percutaneous coronary intervention in patients with ST elevation myocardial infarction: A meta-analysis

The predictors of no reflow phenomenon after percutaneous coronary intervention in patients with ST elevation myocardial infarction: A meta-analysis

Rate and Determinants of Slow Flow / No-Reflow in Patients Undergoing Primary Percutaneous Coronary Intervention at Sandaman Provincial Hospital Quetta

The predictive value of laboratory parameters for no‐reflow phenomenon in patients with ST‐elevation myocardial infarction following primary percutaneous coronary intervention: A meta‐analysis

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