Volume 2, Issue 3, September 2018, Page: 68-74
Predictors of no-Reflow in Patients with ST-Segment Elevation Acute Myocardial Infarction after Primary Percutaneous Coronary Intervention
Mohammed Ismail Ali, Cardiology Department, 6 October Hospital, General Health Insurance, Giza, Egypt
Wala Farid Abd El-Aziz, Cardiology Department, Menoufia University, Menoufia, Egypt
Adel Imam Abd El-Magid, Cardiology Department, National Heart Institute, Giza, Egypt
Neveen Ibrahim Samy, Cardiology Department, Menoufia University, Menoufia, Egypt
Received: Aug. 28, 2018;       Accepted: Oct. 15, 2018;       Published: Nov. 5, 2018
DOI: 10.11648/j.ccr.20180203.15      View  365      Downloads  28
Background: Primary percutaneous coronary intervention (PCI) is the preferred method of ST-segment elevation acute myocardial infarction (STEMI) management but no-reflow phenomenon is one of its major complications that affects patient's outcome. Objective: Identification of possible clinical, angiographic and procedural predictors for no-reflow in patients with AMI after primary percutaneous coronary intervention (PCI). Methods: A total of hundred patients with AMI who had been treated by primary PCI at the National heart institute (NHI) and cardiology department, Menoufia University hospital were enrolled in this study, according to thrombolysis in myocardial infarction (TIMI) flow grade, patients were divided into a reflow group (TIMI 3) and a no-reflow group (TIMI ≤ 2). The clinical, angiographic and procedural data were compared between both groups. Discussion: Sixteen patients (16%) developed no-reflow phenomenon after primary PCI. Statistical analysis showed that time from onset to reperfusion, low initial TIMI flow grade, high thrombus burden, long lesion length and large reference luminal diameter were correlated with no-reflow (P < 0.05 for all) and were considered to be independent predictors of no-reflow. Conclusion: The occurrence of no-reflow after primary PCI for acute myocardial infarction can be predicted by certain clinical, angiographic and procedural features.
Acute Myocardial Infarction, Primary Percutaneous Coronary Intervention, No-Reflow, Coronary Thrombosis
To cite this article
Mohammed Ismail Ali, Wala Farid Abd El-Aziz, Adel Imam Abd El-Magid, Neveen Ibrahim Samy, Predictors of no-Reflow in Patients with ST-Segment Elevation Acute Myocardial Infarction after Primary Percutaneous Coronary Intervention, Cardiology and Cardiovascular Research. Vol. 2, No. 3, 2018, pp. 68-74. doi: 10.11648/j.ccr.20180203.15
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Kirma C, Akin Izgi, Cihan Dundar, et al.: Clinical and Procedural Predictors of No-Reflow Phenomenon after Primary Percutaneous Coronary Interventions. Circ J 2008; 72: 716–721.
Nagao K, Hayashi N, Kanmatsuse K, et al.: An early and complete reperfusion strategy for acute myocardial infarction using fibrinolysis and subsequent transluminal therapy: The FAST trial. Circ J 2002; 66: 576–582.
Anderson JL, Karagounis L, Becker LC, et al.: TIMI perfusion grade 3 but not grade 2 results in improved outcome after thrombolysis for myocardial infarction: Ventriculographic, enzymatic, and electrocardiographic evidence from the TEAM-3 study. Circulation 1993; 87: 1829–1839.
Cura F, L’Allier P, Kapadia SR, et al.: Predictors and prognosis of suboptimal coronary blood flow after primary coronary angioplasty in patients with acute myocardial infarction. Am J Cardiol 2001; 88: 124–128.
Zhou H, Xiao-yan He, Shao-wei Zhuang, et al.: Clinical and procedural predictors of no-reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention. Department of Cardiology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China. World J Emerg Med, Vol 5, No 2, 2014.
Gibson, CM, de Lemos, JA, et al.: "Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation. 2001, 103 (21): 2550–4.
Bonaa KH, Mannsverk J, Wiseth R, et al.: Drug-eluting or bare-metal stents for coronary artery disease. N Engl J Med 2016; 375(13):1242–1252.
Elgendy IY, Mahmoud AN, Kumbhani DJ, et al.: Complete or culprit only revascularization for patients with multi-vessel coronary artery disease undergoing percutaneous coronary intervention: a pair wise and network meta-analysis of randomized trials. JACC Cardiovasc Interv 2017; 10 (4):315–324.
Ten Berg JM, van’t Hof AW, Dill T, et al.: Effect of early, pre-hospital initiation of high bolus dose tirofiban in patients with ST-segment elevation myocardial infarction on short- and long-term clinical outcome. J Am Coll Cardiol 2010; 55 (22):2446–2455.
Kelbaek H, Hofsten DE, Kober L, et al.: Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomized controlled trial. Lancet 2016; 387(10034):2199–2206.
Watanabe T, Nanto S, Uematsu M, et al.: Prediction of No-Reflow Phenomenon after Successful Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction Circulation Journal Vol.67, August 2003.
Tanaka A, Kawarabayashi T, Yoshiharu et al.: No-Reflow Phenomenon and Lesion Morphology in Patients with Acute Myocardial Infarction Circulation. 2002; 105:2148-2152.
Morishima I, Sone T, Okumura K, et al.: Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first myocardial infarction. J Am Coll Cardiol. 2000; 36:1202–1209.
Mazhar J, Maschicharan M, Farshid A. Predictors and outcome of no reflow post primary percutaneous coronary intervention for ST-elevation myocardial infarction. IJC Heart Vasc. 2016; 10:8–12.
Chen Y, Wang C, Xinchun, et al.: Independent no-reflow predictors in female patients with ST-elevation acute myocardial infarction treated with primary percutaneous coronary intervention Heart Vessels (2012) 27:243–249.
Niccoli G, Burzotta F, Galiuto L, et al.: Myocardial no-reflow in humans. J Am Coll Cardiol. 2009; 54:281–292.
Reffelmann T and Kloner RA. The no-reflow phenomenon: Basic science and clinical correlates. Heart 2002; 87: 162– 168.
B. G. Schwartz and R. A. Kloner, Coronary no reflow, J. Mol. Cell. Cardiol. 52 (4) (2012) 873–882.
Nagata Y, Usuda K, Uchiyama A, et al.: Characteristics of the pathological images of coronary artery thrombi according to the infarct-related coronary artery in acute myocardial infarction. Circ J 2004; 68: 308–314.
Yip HK, Chen MC, Chang HW, et al.: Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon. Chest 2002; 122:1322–32.
De Luca G, Suryapranata H, Zijlstra F, et al.: Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol 2003; 42: 991–997.
Dong-bao, H. Qi, L. Zhi, et al.: Predictors and long-term prognosis of angiographic slow/no-reflow phenomenon during emergency percutaneous coronary intervention for ST-elevated acute myocardial infarction, Clin. Cardiol. 33 (12) (2010) E7–12.
De Luca G, Ernst N, Zijlstra F, et al.: Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol 2004; 43: 1363–1367.
Katayama T, Kubo N, Takagi Y, et al.: Relation of atherothrombosis burden and volume detected by intravascular ultrasound to angiographic no-reflow phenomenon during stent implantation in patients with acute myocardial infarction. Am J Cardiol 2006; 97: 301–304.
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