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[The no-reflow phenomenon: its incidence and clinical characteristics in a series of cases]
E Vallejo1, M A Peña-Duque, O Noroño
1Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Insights
The no-reflow phenomenon, a complication after coronary angioplasty, occurred in 5.2% of patients. This incidence is higher than previously reported, highlighting the need for further investigation into this reperfusion issue.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Context:
- The no-reflow phenomenon is a critical complication following percutaneous coronary intervention (PCI), characterized by impaired myocardial reperfusion despite successful artery opening.
- Understanding the incidence and clinical predictors of no-reflow is crucial for improving patient outcomes after angioplasty.
- Previous reports on no-reflow incidence after PCI vary, necessitating contemporary data from diverse patient populations.
Purpose:
- To determine the incidence and clinical characteristics of the no-reflow phenomenon in patients undergoing elective and direct percutaneous transluminal coronary angioplasty (PTCA).
- To identify common risk factors, affected coronary arteries, and reperfusion times associated with no-reflow.
- To evaluate the effectiveness of intracoronary verapamil as a strategy to restore antegrade flow.
Summary:
- This study reviewed 204 elective and 62 direct angioplasties, identifying 14 patients with no-reflow (overall incidence 5.2%).
- No-reflow was more prevalent in men (mean age 56), with diabetes and smoking as key risk factors.
- The left anterior descending artery was most frequently involved; intracoronary verapamil was the primary treatment for restoring flow, with a mean reperfusion time of 10.6 hours in direct angioplasty cases.
Impact:
- The findings suggest that the incidence of no-reflow after both elective (1.9%) and direct (16.12%) angioplasty may be higher than previously documented.
- This study underscores the clinical significance of the no-reflow phenomenon and its potential impact on myocardial recovery.
- Results emphasize the need for optimized strategies to prevent and manage no-reflow during coronary revascularization procedures.
Abstract:
The no-reflow phenomenon refers to the inability to reperfuse myocardial tissue despite removal of an occlusion of a coronary artery. No reflow is a complication that may occur after revascularization of patients. This study examined the incidence and, clinical characteristics of no-reflow in a patient population treated with conventional percutaneous transluminal coronary angioplasty at the Instituto Nacional de Cardiología "Ignacio Chávez". We reviewed 204 elective angioplasties and 62 direct angioplasties; 14 patients were included (4 from the first group and 10 from the second group). No-reflow were more frequently in men, the mean age was 56 years and diabetes and smoking were the risk factors more frequently reported. No-reflow was found in left anterior descending coronary artery in 7 patients, the time of reperfusion, in direct angioplasty, was 10.6 hours (mean) and the strategy most frequently used to reestablish normal anterograde flow was intracoronary verapamil. The overall incidence of no-reflow for the two modalities was 5.2% (16.12% for direct angioplasty and 1.9% for elective angioplasty). The current study shows that the no-reflow phenomenon is not uncommon after angioplasty; no-reflow appears higher than the previous reports for both modalities of treatment.