Related Experiment Video
Updated: Mar 30, 2026
Author Spotlight: Improved Localization and Monitoring of Coronary Flow Reserve Using Modified PLAX View in Mice
Published on: August 25, 2023
[No reflow: What are the predictors?]
M Chettibi1, S Benghezel1, S Bertal1
1Service de cardiologie et de médecine interne, CHU Frantz-Fanon, Blida, Algérie; Université Saad Dahleb, Blida, Algérie.
Insights
No reflow, a common complication in ST-elevation myocardial infarction, is linked to higher mortality. Key predictors include age, heart rate, diabetes, and direct stenting, with delayed stenting potentially reducing this risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- Significant advancements in ST-elevation acute coronary syndrome (ACS) recanalization have been made.
- Coronary recanalization is necessary but insufficient, as 20-50% of cases experience "no reflow" (illusion of reperfusion).
Purpose of the Study:
- To identify predictors of poor perfusion, or "no reflow," during the acute phase of myocardial infarction.
Main Methods:
- An observational prospective study was conducted over 28 months.
- Patients with acute myocardial infarction undergoing primary angioplasty or thrombolysis with angiographic control were included.
- No reflow was defined as ST-segment regression <50%.
Main Results:
- 38.8% of 379 patients developed no reflow, which strongly correlated with 3.9% mortality.
- Multivariate analysis identified age, heart rate, type 2 diabetes, reaching the core, and direct stenting as predictors of no reflow.
- Deferred stenting strategy showed a lower rate of reocclusion and stenting compared to immediate stenting.
Conclusions:
- No reflow is a frequent complication associated with increased mortality.
- Predictors include age, heart rate, diabetes, reaching the core, and direct stenting.
- Delayed stenting may mitigate distal embolization and improve outcomes.
Introduction:
During the past 20 years, significant progress has been made in the recanalization of ACS with ST elevation. It is now accepted that the reopening of the large coronary vessels in the acute phase of infarction by thrombolysis or angioplasty is necessary but not sufficient, because in 20-50% of cases, the coronary recanalization is an illusion of reperfusion. This phenomenon is called "no reflow".
Objective:
The main objective of our study was to identify predictors of poor perfusion or "no reflow" in the acute phase of myocardial infarction.
Methods:
Observational prospective study, in the department of cardiology and internal medicine, university hospital of Blida, over a period of 28 months from 1st September 2010 to 31st January 2013. We identified all patients hospitalized for myocardial infarction in acute phase, who underwent primary angioplasty or thrombolysis with angiographic control during a good TIMI flow. The endpoint was regression of ST segment (regression<50% ST-segment defined no reflow).
Results:
Three hundred and seventy-nine patients were included. The mean age was 56.3±2.1, 87.8% of patients were male. In total, 35.9% hypertensive, 27.1% diabetic type 2, 50.1% and 10.8% dyslipidemia, smoking. One hundred and forty-seven (38.8%) developed a no reflow. Mortality was 3.9%, strongly correlated with no reflow (P=0.001). Predictors of no reflow after multivariate analysis were: age (OR 98, 0.961-0.996 95%, P=0.02), heart rate (1.01, 95% CI 0.998-1.02, P=0.035), the type 2 diabetes (odds ratio 1.87, CI 1.2-3.0, P=0.08), reaching the core (OR 7, 95% CI 1.2-18.4, P=0.027), direct stenting (OR 0.48, 95% CI 0.31-0.78, P=0.003). An interesting subgroup of patients was identified namely the subgroup strategy deferred primary angioplasty with stenting best reperfusion (OR 3.7, 95% CI 1.5-8.8, P=0.04), a lower rate of reocclusion of culprit artery and a lower rate of stenting with 23/51 (45.1%) versus 136/136 (100%) of immediate stenting group with a P<0.001.
Conclusion:
No reflow is a common phenomenon, strongly correlated with mortality predictors are age, heart rate, diabetes, achieving the core and direct stenting. The distal embolization in primary angioplasty is an important phenomenon, a delayed stenting strategy appears to limit this phenomenon.
