Predictors and outcome of no-reflow post primary percutaneous coronary intervention for ST elevation myocardial infarction

Abstract

BackgroundNo-reflow (TIMI < 3) during primary PCI (PCI) for STEMI occurs in 11–41% of cases, indicates poor myocardial tissue perfusion, and is associated with a poor outcome. We aimed to determine predictors and 12 month outcomes of patients who developed no-reflow.MethodsWe analysed the PCI database of The Canberra Hospital and identified 781 patients who underwent primary PCI during 2008–2012. Follow-up at 12 months was with letter, phone call and review of hospital records.ResultsNo-reflow was observed in 189 patients (25%) at the end of the procedure. Patients with no-reflow were older (64 vs. 61 years, p = 0.03). No-reflow patients were more likely to have initial TIMI flow < 3 (89% vs. 79%, p = 0.001), thrombus score ≥ 4 (83% vs. 69%, p = 0.0001), higher use of glycoprotein IIb/IIIa inhibitors (57% vs. 48%, p = 0.03) and longer median symptom to balloon time (223 min vs. 192 min, p = 0.004). No-reflow was an independent predictor of mortality (HR 1.95, CI 1.04-3.59, p = 0.037) during 12 month follow-up. On multivariate analysis, age > 60 years, thrombus score ≥ 4 and symptom to balloon time > 360 min were independent predictors of no-reflow. In 17% of cases of no reflow, it occurred only after stent insertion.ConclusionsNo-reflow occurred in 25% of STEMI patients undergoing primary PCI and was more likely with older age, high thrombus burden and delayed presentation. No-reflow was associated with a higher risk of death at 12 month follow-up.

Predictors of no-Reflow in Patients with ST-Segment Elevation Acute Myocardial Infarction after Primary Percutaneous Coronary Intervention

“…Significant longer reperfusion time in patients with noreflow was concordant to many studies [1,5,14] but discordant to others [11][12][13]15].…”

“…Myocardial blush grade was not used as most angiogram films were not acquired long enough to estimate the MBG and the TIMI flow grade classification system was used only to assess epicardial coronary blood flow. This was concordant to many studies [1,5,[11][12][13][14] but discordant to Chen who used TIMI flow grade system and MBG to define no-reflow [15].…”

“…These data were exactly the same as Mazhar and Chen [14,15] and close to Kirma and Zhou [1,5] who demonstrated that in addition to lower initial TIMI flow grade and higher thrombus burden degree, significantly more prevalence of total occlusion in the no-reflow patients but discordant to Tanaka who demonstrated that no statistically significant difference between reflow and no-reflow patients regarding all angiographic data [12] and Morishima who demonstrated that anterior infarction location was significantly higher in the no-reflow patients [13].…”

Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention

“…This effect is known as the no-reflow phenomenon. In a recent work published by Hassan et al, 2018, they reported a 30 % no-reflow in patients with PPCI in Assuit University [13] while Mazhar et al, 2016 [14] reported 25% no-reflow in their patients' group. In this study we chose to examine patients who experienced no-reflow as a case control study.…”

An hs-TNT Second Peak Associated with High CRP at Day 2 Appears as Potential Biomarkers of Micro-Vascular Occlusion on Magnetic Resonance Imaging after Reperfused ST-Segment Elevation Myocardial Infarction

“…However, the pathophysiological explanations and clinical implications of this biphasic shape had not been fully established. MVO is independently correlated with poor outcome after STEMI [4,[27][28][29]. There are conflicting results regarding the predictive factors for MVO [3,4].…”