Related Experiment Video
Updated: Mar 15, 2026
Author Spotlight: Improved Localization and Monitoring of Coronary Flow Reserve Using Modified PLAX View in Mice
Published on: August 25, 2023
Association of endothelial dysfunction and no-reflow during primary percutaneous coronary intervention for
Yaniv Levi1, Ayyaz Sultan1, Mistre Alemayehu2
1Western University, N6A 5A5 London, ON, Canada; London Health Sciences Centre, N6A 5A5 London, ON, Canada.
Insights
Endothelial dysfunction does not predict no-reflow during primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI) patients. Peripheral vascular function assessments showed no significant differences between groups, suggesting other factors influence no-reflow.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Cardiology
Background:
- Coronary no-reflow after primary percutaneous coronary intervention (PPCI) is linked to adverse cardiovascular outcomes.
- Both endothelial dysfunction and no-reflow involve vascular and hemostatic abnormalities.
Purpose of the Study:
- To investigate the association between systemic peripheral endothelial dysfunction and the occurrence of no-reflow during PPCI in ST-elevation myocardial infarction (STEMI) patients.
Main Methods:
- Compared 30 STEMI patients with normal flow post-PPCI to 19 STEMI patients with no-reflow.
- Assessed peripheral endothelial function using reactive hyperemia index (RHI) with the EndoPAT device 48-72 hours post-PPCI.
Main Results:
- No significant difference in RHI was observed between the no-reflow and normal flow groups (p=0.24).
- The no-reflow group showed less ST segment resolution (p=0.001) and lower ejection fraction (p=0.015) post-PPCI.
- Smokers were less likely to experience no-reflow.
Conclusions:
- Systemic peripheral endothelial function does not differ between STEMI patients who experience no-reflow and those who do not during PPCI.
- These findings suggest that peripheral endothelial function is not a primary determinant of no-reflow in this context.
Background:
Coronary no-reflow during primary percutaneous coronary intervention (PPCI) is a predictor of poorer cardiovascular outcome. Both endothelial dysfunction and no-reflow involves abnormal vascular function and hemostasis. Our aim was to assess the association between endothelial dysfunction and no reflow during primary PCI.
Methods:
Thirty consecutive patients with ST elevation myocardial infarction (STEMI) and normal flow during primary PCI were compared to 19 consecutive patients who had no reflow. All subjects underwent assessment of peripheral endothelial function by reactive hyperemia index (RHI) 48-72h post PCI using the EndoPAT device.
Results:
Age, sex and hypertension were similar in both groups. Smokers were less likely to have no-reflow. Post PPCI there was less ST segment resolution in the no-reflow group (48%±7 vs. 81%±6; p=0.001). Patients who had no reflow had subsequently lower ejection fraction (39%±10 vs. 47%±10; p=0.015). There was no difference in vascular function (RHI), between the no-reflow and normal flow groups (1.91±0.3 vs. 2.09±0.11; p=0.24).
Conclusions:
Systemic peripheral endothelial function does not differ between STEMI patients with and without no reflow during primary PCI.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies