The Diagnosis and Treatment of the No-reflow Phenomenon in Patients with Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Overview

Journal Exp Clin Cardiol

Specialty Cardiology & Vascular Diseases

Date 2009 Apr 4

PMID 19343126

Citations 26

Authors

Khalill Ramjane

Lei Han

Chang Jin

Affiliations

Soon will be listed here.

Abstract

Objective: To review the diagnosis and treatment available for myocardial infarction patients having no-reflow in the setting of percutaneous coronary intervention (PCI).

Data Sources: Data for the present review were obtained from searches in PubMed (1997 to 2007) using the following key terms: "acute myocardial infarction", "no-reflow phenomenon", "myocardial contrast echocardiography", "coronary angiography" and "cardioprotection devices".

Study Selection: Mainly original articles and critical reviews written by major research pioneers in interventional cardiology were selected.

Results: Despite a fully patent coronary artery post-PCI for myocardial infarction, patients may experience inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evidence of mechanical vessel obstruction. This phenomenon is defined as no-reflow and is a growing problem in the field of interventional cardiology. Although voluminous clinical trial data are available, the exact mechanisms involved and which treatment should be administered as first-line therapy are currently unknown. The different techniques used to diagnose no-reflow also have their pros and cons; myocardial contrast echocardiography and coronary angiography are the most reliable techniques. In cases when no-reflow was successfully reversed, patient recovery was associated with favourable left ventricular remodelling and increased left ventricular ejection fraction, even in the absence of significant improvement in regional contractile function.

Conclusion: Based on the trials in the literature, myocardial contrast echocardiography is the gold standard for the diagnosis of no-reflow. If no-reflow occurs following PCI, treatment with intracoronary adenosine or verapamil should be administered, because this form of therapy is inexpensive and safe, improves flow in the target vessel and may reduce infarct size.

Citing Articles

Type of thrombus, no reflow and outcomes of coronary intervention in ACS patients: OCT-guided study.

Abdelmonaem M, Reda A, Farouk M Br J Cardiol. 2024; 30(4):30.

PMID: 39247414 PMC: 11376251. DOI: 10.5837/bjc.2023.030.

Myocardial Ischemia-Reperfusion Injury: Unraveling Pathophysiology, Clinical Manifestations, and Emerging Prevention Strategies.

Sagris M, Apostolos A, Theofilis P, Ktenopoulos N, Katsaros O, Tsalamandris S Biomedicines. 2024; 12(4).

PMID: 38672157 PMC: 11048318. DOI: 10.3390/biomedicines12040802.

The predictive value of laboratory parameters for no-reflow phenomenon in patients with ST-elevation myocardial infarction following primary percutaneous coronary intervention: A meta-analysis.

Wang L, Huang S, Zhou Q, Dou L, Lin D Clin Cardiol. 2024; 47(2):e24238.

PMID: 38400562 PMC: 10891415. DOI: 10.1002/clc.24238.

Association of stress induced hyperglycemia with angiographic findings and clinical outcomes in patients with ST-elevation myocardial infarction.

Stalikas N, Papazoglou A, Karagiannidis E, Panteris E, Moysidis D, Daios S Cardiovasc Diabetol. 2022; 21(1):140.

PMID: 35883091 PMC: 9327277. DOI: 10.1186/s12933-022-01578-6.

A Narrative Review of the Classical and Modern Diagnostic Methods of the No-Reflow Phenomenon.

Pantea-Rosan L, Bungau S, Radu A, Pantea V, Moisi M, Vesa C Diagnostics (Basel). 2022; 12(4).

PMID: 35453980 PMC: 9029120. DOI: 10.3390/diagnostics12040932.

References

Pasceri V, Pristipino C, Pelliccia F, Granatelli A, Speciale G, Roncella A . Effects of the nitric oxide donor nitroprusside on no-reflow phenomenon during coronary interventions for acute myocardial infarction. Am J Cardiol. 2005; 95(11):1358-61. DOI: 10.1016/j.amjcard.2005.01.082. View

Staat P, Rioufol G, Piot C, Cottin Y, Cung T, LHuillier I . Postconditioning the human heart. Circulation. 2005; 112(14):2143-8. DOI: 10.1161/CIRCULATIONAHA.105.558122. View

Mahaffey K, Puma J, Barbagelata N, DiCarli M, Leesar M, Browne K . Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial. J Am Coll Cardiol. 1999; 34(6):1711-20. DOI: 10.1016/s0735-1097(99)00418-0. View

Rezkalla S, Kloner R . No-reflow phenomenon. Circulation. 2002; 105(5):656-62. DOI: 10.1161/hc0502.102867. View

Iwakura K, Ito H, Ikushima M, Kawano S, Okamura A, Asano K . Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction. J Am Coll Cardiol. 2003; 41(1):1-7. DOI: 10.1016/s0735-1097(02)02626-8. View

Ito H, Taniyama Y, Iwakura K, Nishikawa N, Masuyama T, Kuzuya T . Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol. 1999; 33(3):654-60. DOI: 10.1016/s0735-1097(98)00604-4. View

Micari A, Belcik T, Balcells E, Powers E, Wei K, Kaul S . Improvement in microvascular reflow and reduction of infarct size with adenosine in patients undergoing primary coronary stenting. Am J Cardiol. 2005; 96(10):1410-5. DOI: 10.1016/j.amjcard.2005.06.090. View

Assali A, Sdringola S, Ghani M, Denkats A, Yepes A, Hanna G . Intracoronary adenosine administered during percutaneous intervention in acute myocardial infarction and reduction in the incidence of "no reflow" phenomenon. Catheter Cardiovasc Interv. 2000; 51(1):27-31; discussion 32. DOI: 10.1002/1522-726x(200009)51:1<27::aid-ccd7>3.0.co;2-0. View

Serruys P, Ijsselmuiden S, van Hout B, Vermeersch P, Bramucci E, Legrand V . Direct stenting with the Bx VELOCITY balloon-expandable stent mounted on the Raptor rapid exchange delivery system versus predilatation in a European randomized Trial: the VELVET trial. Int J Cardiovasc Intervent. 2003; 5(1):17-26. DOI: 10.1080/14628840304607. View

10.

Mizote I, Ueda Y, Ohtani T, Shimizu M, Takeda Y, Oka T . Distal protection improved reperfusion and reduced left ventricular dysfunction in patients with acute myocardial infarction who had angioscopically defined ruptured plaque. Circulation. 2005; 112(7):1001-7. DOI: 10.1161/CIRCULATIONAHA.104.532820. View

11.

Zabel M, Hohnloser S, Koster W, Prinz M, Kasper W, Just H . Analysis of creatine kinase, CK-MB, myoglobin, and troponin T time-activity curves for early assessment of coronary artery reperfusion after intravenous thrombolysis. Circulation. 1993; 87(5):1542-50. DOI: 10.1161/01.cir.87.5.1542. View

12.

Sherman J, Anwar A, Bret J, Schreibfeder M . Distal vessel pullback angiography and pressure gradient measurement: an innovative diagnostic approach to evaluate the no-reflow phenomenon. Cathet Cardiovasc Diagn. 1996; 39(1):1-6. DOI: 10.1002/(SICI)1097-0304(199609)39:1<1::AID-CCD1>3.0.CO;2-A. View

13.

Abbo K, Dooris M, Glazier S, ONeill W, Byrd D, Grines C . Features and outcome of no-reflow after percutaneous coronary intervention. Am J Cardiol. 1995; 75(12):778-82. DOI: 10.1016/s0002-9149(99)80410-x. View

14.

Eeckhout E, Kern M . The coronary no-reflow phenomenon: a review of mechanisms and therapies. Eur Heart J. 2001; 22(9):729-39. DOI: 10.1053/euhj.2000.2172. View

15.

Agati L, Voci P, Autore C, Luongo R, Testa G, Mallus M . Combined use of dobutamine echocardiography and myocardial contrast echocardiography in predicting regional dysfunction recovery after coronary revascularization in patients with recent myocardial infarction. Eur Heart J. 1997; 18(5):771-9. DOI: 10.1093/oxfordjournals.eurheartj.a015342. View

16.

Keeley E, Boura J, Grines C . Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003; 361(9351):13-20. DOI: 10.1016/S0140-6736(03)12113-7. View

17.

Shimizu M, Wang Q, Sjoquist P, Ryden L . The angiotensin II AT1-receptor antagonist candesartan improves functional recovery and reduces the no-reflow area in reperfused ischemic rat hearts. J Cardiovasc Pharmacol. 1999; 34(1):78-81. DOI: 10.1097/00005344-199907000-00013. View

18.

Przyklenk K, Kloner R . "Reperfusion injury" by oxygen-derived free radicals? Effect of superoxide dismutase plus catalase, given at the time of reperfusion, on myocardial infarct size, contractile function, coronary microvasculature, and regional myocardial blood flow. Circ Res. 1989; 64(1):86-96. DOI: 10.1161/01.res.64.1.86. View

19.

de Lemos J, Antman E, Gibson C, McCabe C, Giugliano R, Murphy S . Abciximab improves both epicardial flow and myocardial reperfusion in ST-elevation myocardial infarction. Observations from the TIMI 14 trial. Circulation. 2000; 101(3):239-43. DOI: 10.1161/01.cir.101.3.239. View

20.

Zhao J, Yang Y, You S, Jing Z, Wu Y, Cheng J . Pretreatment with fosinopril or valsartan reduces myocardial no-reflow after acute myocardial infarction and reperfusion. Coron Artery Dis. 2006; 17(5):463-9. DOI: 10.1097/00019501-200608000-00010. View