Correlates of the "No-Reflow" or "Slow-Flow" Phenomenon in Patients Undergoing Primary Percutaneous Coronary Intervention

Overview

Journal J Tehran Heart Cent

Publisher Tehran University of Medical Sciences

Specialty Cardiology & Vascular Diseases

Date 2019 Feb 13

PMID 30745923

Citations 12

Authors

Mohammad Alidoosti

Reza Lotfi

Masoumeh Lotfi-Tokaldany

Ebrahim Nematipour

Mojtaba Salarifar

Hamidreza Poorhosseini

Arash Jalali

Affiliations

Soon will be listed here.

Abstract

Despite recent advances in interventional equipment and techniques, the angiographic no-reflow phenomenon occurs in a considerable number of patients undergoing primary percutaneous coronary intervention (PCI). We investigated the clinical, angiographic, preprocedural, and procedural characteristics associated with the no-reflow phenomenon among patients undergoing primary PCI. Between March 2008 and April 2013, 530 patients (78.5% male, mean age=58.11±12.39 y) with ST-segment-elevation myocardial-infarction who underwent primary PCI were categorized in 2 groups according to their postprocedural thrombolysis-in-myocardial infarction (TIMI) flow grades: those with a maximum score of 2 (the no-reflow or slow-flow group) and the ones with a score of 3 (the reflow group). A multivariable logistic regression model was used to find the multiple correlates of the no-reflow phenomenon after PCI. There were 166 (31.3%) patients in the no-reflow group and 364 (68.7%) in the reflow group. The no-reflow patients were older and had significantly longer target lesion lengths, higher SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) scores, higher infarct-related artery SYNTAX scores, more thrombus burden, and a higher frequency of initial TIMI flow grades of 2 or lower. Our multivariable logistic regression analysis demonstrated that older age, higher numbers of Q waves, not using statin, longer target lesion lengths, higher thrombus grades, and higher infarct-related artery SYNTAX scores remained the independent correlates of increased no-reflow rates after primary PCI (area under the ROC curve=0.784, 95% CI: 0.742-0.826; P<0.001). Clinical, angiographic, and procedural features of patients undergoing primary PCI may be correlated with the occurrence of the no-reflow phenomenon. The thrombus grade and the infarct-related artery SYNTAX score could be among these factors.

Citing Articles

Clinical, laboratory, and procedural predictors of slow flow/no reflow phenomenon after emergency percutaneous coronary interventions in ST-elevated myocardial infarction.

Bamarinejad F, Kermani-Alghoraishi M, Soleimani A, Roohafza H, Yazdekhasti S, Azarm M Egypt Heart J. 2024; 76(1):146.

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Utility of electrocardiogram to predict the occurrence of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention (PPCI): a systematic review and meta-analysis.

Afshar E, Gholami N, Samimisedeh P, MozafaryBazargany M, Tayebi A, Memari A Front Cardiovasc Med. 2024; 10:1295964.

PMID: 38283173 PMC: 10813196. DOI: 10.3389/fcvm.2023.1295964.

The role and mechanisms of microvascular damage in the ischemic myocardium.

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Coronary Arteries Aneurysms: A Case-Based Literature Review.

Vadala G, Di Caccamo L, Alaimo C, Di Fazio L, Ferraiuoli G, Buccheri G Diagnostics (Basel). 2022; 12(10).

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Predictive Value of Soluble Growth Stimulator Gene 2 Protein for Coronary Slow Flow/No-Reflow in ST-Elevation Myocardial Infarction Patients Receiving Percutaneous Coronary Intervention.

Chang S, Yu Y, Luan B, Hou A, Wang Y J Interv Cardiol. 2022; 2022:9322460.

PMID: 35510149 PMC: 9033400. DOI: 10.1155/2022/9322460.

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