ANGIOGRAPHIC NO-REFLOW AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST-ELEVATION MYOCARDIAL INFARCTION: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Angiographic no-reflow is a clinically important complication of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). In a prospective observational study this was established as its prevalence and frequently available clinical parameters associated with its occurrence in 400 consecutive adults undergoing primary PCI. Technically successful PCI without mechanical epicardial obstruction was defined as the final Thrombolysis in Myocardial Infarction flow grade 0-2 in the absence of no-reflow. No-reflow occurred in 80 patients (20.0%; 95% confidence interval [CI], 16.4%-24.2%). Compared with patients achieving normal flow, those with no-reflow were older (61.4 ± 10.2 vs. 56.6 ± 11.2 years; mean difference, 4.80 years; 95% CI, 2.09-7.51; P < 0.001), more frequently had diabetes mellitus (51.3% vs. 31.6%; odds ratio, 2.28; 95% CI, 1.39-3.75; P = 0.001), and had a longer total ischemic time (6.56 ± 2.86 vs. 4.38 ± 2.65 h; mean difference, 2.18 h; 95% CI, 1.52-2.84; P < 0.001). No-reflow was not significantly related to smoking or hypertension. One-fifth of the study population experienced angiographic no-reflow; older age, diabetes mellitus and longer ischemic time were associated with angiographic no-reflow, in unadjusted analysis.