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Morphological predictors for no reflow phenomenon after primary percutaneous coronary intervention in patients with

Tsunenari Soeda1, Takumi Higuma2, Naoki Abe2

  • 1Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

European Heart Journal. Cardiovascular Imaging
|January 24, 2016
PubMed

Insights

Nearly 40% of ST-segment elevation myocardial infarction (STEMI) patients with plaque rupture experienced no reflow after percutaneous coronary intervention (PCI). High lipid index and plaque burden predict no reflow, guiding treatment strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Myocardial no reflow post-percutaneous coronary intervention (PCI) is linked to adverse outcomes.
  • Patients with ST-segment elevation myocardial infarction (STEMI) due to plaque rupture face a high risk of no reflow.
  • Specific plaque morphologies predicting no reflow in STEMI patients remain unclear.

Purpose of the Study:

  • To identify morphological characteristics of culprit plaques associated with myocardial no reflow.
  • To investigate plaque morphology in STEMI patients with plaque rupture using optical coherence tomography (OCT) and intravascular ultrasound (IVUS).

Main Methods:

  • Enrolled 145 STEMI patients undergoing OCT and IVUS within 12 hours of symptom onset.
  • Excluded patients with plaque erosion or calcified nodule, focusing on 72 with plaque rupture.
  • Defined no reflow by Thrombolysis in Myocardial Infarction (TIMI) flow grade 0-2 and/or myocardial blush grade (MBG) 0-1 post-PCI.

Main Results:

  • No reflow occurred in 28 patients (38.9%).
  • Lipid index > 3500 (OCT-derived, AUC 0.77) and plaque burden > 81.5% (IVUS-derived, AUC 0.70) were significant predictors of no reflow.
  • Onset to recanalization time did not differ between groups.

Conclusions:

  • Myocardial no reflow is common in STEMI patients with plaque rupture.
  • Elevated lipid index and substantial plaque burden are key morphological discriminators for no reflow.
  • These findings may inform risk stratification and treatment decisions in STEMI.
Abstract

Keywords:
ST-segment elevation myocardial infarctionno reflowoptical coherence tomographyplaque rupture

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