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Clinical, Laboratory, and Procedural Predictors of No-Reflow in Patients Undergoing Primary Percutaneous Coronary

Maryam Shakiba1,2, Arsalan Salari1, Fardin Mirbolouk1

  • 1Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.

The Journal of Tehran Heart Center
|February 8, 2021
PubMed

Insights

No-reflow after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is predicted by older age, hypertension, diabetes, low blood pressure, cardiovascular history, heart failure, low initial thrombolysis in myocardial infarction (TIMI) flow, and anemia. Stenting was associated with reduced no-reflow risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Myocardial Infarction Management

Background:

  • No-reflow phenomenon is a significant complication in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).
  • Identifying predictors of no-reflow is crucial for improving patient outcomes and guiding therapeutic strategies.
  • This study investigates clinical, laboratory, and procedural factors associated with no-reflow in STEMI patients.

Purpose of the Study:

  • To identify clinical, laboratory, and procedural predictors of the no-reflow phenomenon in patients with STEMI undergoing PPCI.
  • To stratify risk and inform management strategies for patients at high risk of no-reflow.
  • To analyze the association between various patient characteristics and procedural factors with the occurrence of no-reflow.

Main Methods:

  • A cohort of 378 STEMI patients undergoing PPCI between 2015 and 2017 was studied.
  • Patients were categorized into no-reflow and reflow groups based on Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grades.
  • Multivariate logistic regression analysis was employed to determine independent predictors of no-reflow.

Main Results:

  • The no-reflow phenomenon occurred in 77 patients (20.4%).
  • Significant independent predictors of no-reflow included older age (>60 years), hypertension, diabetes mellitus, low systolic blood pressure, history of cardiovascular diseases, chronic heart failure, low initial TIMI flow grade, and anemia.
  • Stenting, compared to balloon angioplasty, was associated with a reduced risk of no-reflow (OR=0.42).

Conclusions:

  • Several clinical (age, hypertension, diabetes, low BP, CVD history, CHF), laboratory (anemia), and procedural (low TIMI flow) factors independently predict no-reflow in STEMI patients undergoing PPCI.
  • These findings aid in identifying high-risk individuals for targeted management.
  • The study highlights the importance of considering these predictors to mitigate the risk of no-reflow and improve outcomes.

Keywords:
No-reflow phenomenonPercutaneous coronary interventionST elevation myocardial infarction

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