Predictive Factors and Impact of No Reflow After Primary Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

Abstract

Background-The investigation of no-reflow phenomenon after percutaneous coronary intervention (PCI) in patients withacute ST-segment-elevation myocardial infarction has therapeutic implications. We investigated the predictive factors, persistence in time, and impact of no reflow on myocardial salvage, ventricular function, and mortality. Methods and Results-The study included 1140 patients with ST-segment-elevation myocardial infarction undergoing primary PCI and paired scintigraphic examinations (before intervention and 7 to 14 days thereafter). After primary PCI, 108 patients had no reflow and 1032 patients had normal coronary flow.

The Predictors of No-Reflow Phenomenon after Primary Angioplasty for Acute Myocardial Infarction

“…The incidence of no-reflow phenomenon has been reported to be 5 -24% in different studies (5)(6)(7)(8)(9)(10). In the present study, the rate of no-reflow phenomenon following the primary PCI was 15.9%, which was similar to other studies.…”

“…Fragmentation of these thrombi following balloon dilatation can lead to distal embolization. Furthermore, prolonged ischemia can lead to alteration in capillary integrity, edema in capillary bed and myocardial cells, and polymorphonuclear cell plugging (2,3,(8)(9)(10). Although the thrombus burden is a very important issue in the occurrence of no-reflow phenomenon, this phenomenon can occur even in patients with lower burden of thrombus if they have a prolonged reperfusion time.…”

Impervious Coronary No-Reflow: A Case Study

“…Age, tobacco use, door-to-balloon time, initial perfusion defect, previous myocardial infarction, serum creatinine, C-reactive protein levels, left ventricular ejection fraction and Killip classification score have been associated with this condition [9]. Our patient although very young, did possess these certain risk factors including smoking, and a delayed door-to-balloon time as his electrocardiogram was normal on presentation and coronary catheterization was pursued urgently rather than emergently.…”

Evaluation of the clinical and procedural predictive factors of no-reflow phenomenon following primary percutaneous coronary intervention

“…Iwakura et al (13) reported the number of abnormal Q-waves and the wall motion score as independent predictive factors. Larger infarct size is another predictive factor, which was evaluated in different studies (5,9,17). We had limitations while performing the study.…”

“…Besides the advantages of this strategy, there are situations in which myocardial reperfusion does not restore to its optimal level (1)(2)(3)(4)(5). This condition, known as "no-reflow" phenomenon, happens in several cases (6).…”