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Frequency and impact of slow flow / no flow in primary percutaneous coronary intervention
Ghazanfer Ali Shah1, Tooba Malik1, Sadaf Farooqi1
1National Institute of Cardiovascular Diseases, Karachi, Pakistan.
Insights
Slow/no flow occurs in 9.5% of primary percutaneous coronary interventions. Clinical factors like smoking and angiographical features such as high thrombus burden predict this complication, impacting hemodynamics.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Slow/no flow is a complication during percutaneous coronary intervention.
- Understanding its predictors and impact is crucial for patient outcomes.
Purpose of the Study:
- Determine the frequency of slow/no flow in primary percutaneous coronary intervention (PCI).
- Identify clinical and angiographical predictors of slow/no flow.
- Investigate the immediate hemodynamic impact of slow/no flow.
Main Methods:
- Cross-sectional study of 559 patients with ST-elevation myocardial infarction undergoing primary PCI.
- Assessment of antegrade flow using Thrombolysis in Myocardial Infarction (TIMI) criteria.
- Analysis of demographic, clinical, angiographical data, and procedural details.
Main Results:
- Slow/no flow occurred in 9.5% of patients.
- Significant predictors included smoking, prior myocardial infarction, heart failure, no pre-infarct angina, cerebrovascular disease, advanced NYHA/Killip classes, and lower ejection fraction.
- Angiographical predictors were total culprit vessel occlusion and high thrombus burden.
- Direct stenting and bare metal stents were associated with less slow/no flow.
- Common immediate impacts were hypotension (49.1%) and bradyarrhythmia (9.4%).
- Hemodynamically unstable ventricular tachycardia occurred in 3.8%, leading to mortality.
Conclusions:
- Clinical history and angiographical features can predict the occurrence of slow/no flow.
- Early identification of predictors can aid in anticipating and potentially mitigating this complication.
Objective:
To determine the frequency of slow/no flow in primary percutaneous coronary intervention, to know the clinical and angiographical predictors of the phenomenon, and to investigate the immediate impact of slow/no flow on haemodnamics.
Method:
The cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from June 2018 to July 2019, and comprised patients presenting with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Demographic and clinical details of the patients were recorded. The antegrade flow was assessed and determined using the thrombolysis in myocardial infarction criterion. Patients were assessed for the occurrence, predictors and impact of slow/no flow. Data was analysed using SPSS 21.
Results:
Of the 559 patients, 441(78.9%) were males. The overall mean age of the sample was 55.86±11.07 years. Angiographical slow/no flow during the procedure occurred in 53 (9.5%) patients, while normal flow was achieved in 506(90.5%). The thrombolysis in myocardial infarction grade in the affected patients was 0 in 10(1.8%), 1 in 15(2.7%), and 2 in 28(5%) patients. Smoking status, prior myocardial infarction, prior heart failure, no history of pre-infarct angina, cerebrovascular disease, New York Heart Association class III or IV, Killip class III or IV, and lower ejection fraction were significant predictors of slow/no flow (p<0.05). The angiographical and procedural predictors were total occlusion of culprit vessel and high thrombus burden (p<0.05). Direct stenting and use of bare metal stents had significantly less chance of developing slow/no flow (p<0.05). The most common immediate impact was hypotension 26(49.1%) and bradyarrhythmia 5(9.4%). However, 2(3.8%) patients developed haemodnamically unstable ventricular tachycardia that resulted in mortality.
Conclusions:
Predictors on the basis of history and angiographical features can be taken into account to anticipate the occurrence of slow/no flow phenomenon.
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