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Clinical and Angiographic Predictors of No-Reflow and Its Impact on Outcomes in ST-Elevation Myocardial Infarction: A
Husnain Bashir1, F N U Berkha1, Jahanzeb Malik2
1Department of Medicine, Ibn e Seena Hospital, Kabul, Afghanistan.
Insights
The no-reflow phenomenon in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) is linked to worse outcomes. Predictors include age, diabetes, and thrombus burden, highlighting the need for early identification and prevention strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- The no-reflow phenomenon is a critical complication following primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
- Understanding its predictors and impact is crucial for improving patient outcomes.
Purpose of the Study:
- To identify clinical and angiographic predictors of the no-reflow phenomenon in STEMI patients undergoing primary PCI.
- To evaluate the impact of no-reflow on short- and long-term outcomes.
Main Methods:
- Retrospective analysis of 2925 STEMI patients undergoing primary PCI.
- Stratification into no-reflow and normal flow groups based on final Thrombolysis In Myocardial Infarction (TIMI) flow.
- Multivariate logistic regression to determine independent predictors of no-reflow.
Main Results:
- No-reflow occurred in 18% of patients.
- Predictors included older age, diabetes, Killip class ≥ II, high thrombus burden, pre-PCI TIMI 0 flow, and longer symptom-to-door time. GP IIb/IIIa inhibitors showed a protective effect.
- No-reflow was associated with higher in-hospital mortality (17.3% vs. 4.5%), lower LVEF, and increased 1-year Major Adverse Cardiovascular Events (MACE) (40.5% vs. 16.4%).
Conclusions:
- The no-reflow phenomenon is predictable using routine clinical and angiographic data.
- No-reflow is significantly associated with adverse short- and long-term outcomes in STEMI patients post-PCI.
- Early identification of patients at risk for no-reflow may allow for targeted preventive interventions.
Objective:
To identify clinical and angiographic predictors of the no-reflow phenomenon and evaluate its impact on short- and long-term outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
Methods:
This retrospective study included 2925 patients who underwent primary PCI for STEMI between January 2020 and July 2025. Patients were stratified into no-reflow and normal flow groups based on final TIMI flow. Baseline clinical, angiographic, and procedural data were analyzed. Multivariate logistic regression identified independent predictors of no-reflow.
Results:
The no-reflow phenomenon occurred in 526 patients (18%). Independent predictors included older age, diabetes mellitus, Killip class ≥ II, high thrombus burden, pre-PCI TIMI 0 flow, and longer symptom-to-door time. Use of GP IIb/IIIa inhibitors was protective. No-reflow patients had higher in-hospital mortality (17.3% vs. 4.5%), lower LVEF, and increased 1-year MACE (40.5% vs. 16.4%). Kaplan-Meier curves confirmed significantly reduced MACE-free survival (log-rank p < 0.001).
Conclusion:
The no-reflow phenomenon is associated with adverse outcomes and can be predicted using routine clinical and angiographic features. Early identification may enable targeted preventive strategies.
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