FREQUENCY OF NO-REFLOW IN PRIMARY PCI WITH PRE DILATATION AND WITHOUT PRE-DILATATION: A RETROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: No-reflow following primary percutaneous coronary intervention (PCI) remains a clinically significant complication, associated with adverse myocardial outcomes despite successful epicardial vessel recanalization. Data on its contemporary frequency and the influence of procedural strategy in real-world settings remain limited. Objectives: To determine the frequency of no-reflow in a consecutive cohort of patients undergoing primary PCI, and to evaluate the impact of direct stenting versus balloon pre-dilatation on reflow outcomes. Methods: This retrospective observational study included 72 consecutive patients presenting with acute ST-elevation myocardial infarction (STEMI) requiring primary PCI at Army Cardiac Hospital, Lahore. All procedures used 6 French access and third-generation drug-eluting stents. Procedural strategy was operator-determined. Reflow was classified as Type A (normal, TIMI 3), Type B (transient no-reflow, requiring intracoronary vasodilators), or Type C (persistent no-reflow, TIMI ≤2 at procedure end). Results: Mean age was 56.5 years; 88.9% were male. The LAD was the most frequent target vessel (44.4%). Pre dilatation was used in 53 cases (73.6%) and direct stenting in 19 (26.4%). Normal reflow was achieved in 55 patients (76.4%). The overall no-reflow rate was 23.6%, comprising transient no-reflow in 6 cases (8.3%) and persistent no reflow in 11 (15.3%). No-reflow occurred in 28.3% of the pre-dilatation group versus 10.5% in the direct stenting group, with persistent no-reflow exclusively in the pre-dilatation arm (20.8% vs 0%). Conclusion: No-reflow occurred in nearly one in four patients undergoing primary PCI in this cohort. Direct stenting was associated with substantially lower no-reflow rates compared to pre-dilatation and may represent a preferable strategy in suitable lesions to reduce microvascular injury during primary PCI.