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Correlates of the "No-Reflow" or "Slow-Flow" Phenomenon in Patients Undergoing Primary Percutaneous Coronary
Mohammad Alidoosti1, Reza Lotfi1, Masoumeh Lotfi-Tokaldany1
1Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
The no-reflow phenomenon after primary percutaneous coronary intervention (PCI) is linked to patient age, lesion length, thrombus burden, and SYNTAX scores. Identifying these factors can help predict and potentially mitigate no-reflow complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- The no-reflow phenomenon, characterized by impaired myocardial blood flow despite successful coronary artery reperfusion, remains a significant complication of primary percutaneous coronary intervention (PCI).
- Despite advancements in interventional techniques and equipment, a considerable number of patients undergoing primary PCI experience this adverse outcome.
- Understanding the factors contributing to no-reflow is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the clinical, angiographic, preprocedural, and procedural characteristics associated with the no-reflow phenomenon in patients undergoing primary PCI.
- To identify independent predictors of the no-reflow phenomenon after primary PCI.
Main Methods:
- A cohort of 530 patients with ST-segment-elevation myocardial infarction undergoing primary PCI between March 2008 and April 2013 were analyzed.
- Patients were categorized into no-reflow (Thrombolysis In Myocardial Infarction [TIMI] flow grade ≤2) and reflow (TIMI flow grade 3) groups.
- Multivariable logistic regression analysis was employed to determine the correlates of the no-reflow phenomenon.
Main Results:
- 31.3% of patients (166/530) experienced the no-reflow phenomenon.
- No-reflow patients were older and had longer target lesion lengths, higher SYNTAX scores (overall and infarct-related artery), and greater thrombus burden.
- Independent predictors of no-reflow included older age, increased Q waves, non-use of statins, longer target lesion lengths, higher thrombus grades, and higher infarct-related artery SYNTAX scores (AUC=0.784).
Conclusions:
- Clinical, angiographic, and procedural factors are significantly correlated with the occurrence of the no-reflow phenomenon following primary PCI.
- Thrombus grade and infarct-related artery SYNTAX score emerged as key independent predictors.
- These findings highlight the importance of assessing these factors to potentially reduce the incidence of no-reflow.
Abstract:
Background: Despite recent advances in interventional equipment and techniques, the angiographic no-reflow phenomenon occurs in a considerable number of patients undergoing primary percutaneous coronary intervention (PCI). We investigated the clinical, angiographic, preprocedural, and procedural characteristics associated with the no-reflow phenomenon among patients undergoing primary PCI. Methods: Between March 2008 and April 2013, 530 patients (78.5% male, mean age=58.11±12.39 y) with ST-segment-elevation myocardial-infarction who underwent primary PCI were categorized in 2 groups according to their postprocedural thrombolysis-in-myocardial infarction (TIMI) flow grades: those with a maximum score of 2 (the no-reflow or slow-flow group) and the ones with a score of 3 (the reflow group). A multivariable logistic regression model was used to find the multiple correlates of the no-reflow phenomenon after PCI. Results: There were 166 (31.3%) patients in the no-reflow group and 364 (68.7%) in the reflow group. The no-reflow patients were older and had significantly longer target lesion lengths, higher SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) scores, higher infarct-related artery SYNTAX scores, more thrombus burden, and a higher frequency of initial TIMI flow grades of 2 or lower. Our multivariable logistic regression analysis demonstrated that older age, higher numbers of Q waves, not using statin, longer target lesion lengths, higher thrombus grades, and higher infarct-related artery SYNTAX scores remained the independent correlates of increased no-reflow rates after primary PCI (area under the ROC curve=0.784, 95% CI: 0.742-0.826; P<0.001). Conclusion: Clinical, angiographic, and procedural features of patients undergoing primary PCI may be correlated with the occurrence of the no-reflow phenomenon. The thrombus grade and the infarct-related artery SYNTAX score could be among these factors.