PREDICTORS OF NO-REFLOW PHENOMENON AFTER PRIMARY PCI IN ACUTE MYOCARDIAL INFARCTION

Abstract

Background: The background of the No-reflow phenomenon (NRP) is that it is a serious complication of the primary percutaneous coronary intervention (PCI) performed in patients suffering from acute myocardial infarction (AMI). It refers to failure of the myocardium to receive perfusion despite successful opening of the epicardial coronary artery and there is an increased morbidity and mortality risk. It is believed that inflammatory processes, electrolyte disturbances and haematological parameters may play a role in its occurrence.

Objective: To explore the clinical and laboratory characteristics associated with no-reflow following primary PCI for AMI patients, and to see if the levels of serum magnesium, C-reactive protein (CRP) and white blood cell (WBC) count are associated with one another.

Methods: Retrospective study was carried out with 384 records of AMI patients in Cardiology Department of The Punjab Institute of Cardiology Hospital, Lahore from January 2025 to July 2025. Patients >18 years of age who had a confirmed AMI diagnosis and laboratory tests for WBC, CRP and magnesium were done within 24 hours of admission were included in the study. The sample size was determined according to the formula given by WHO. Association of laboratory parameters and no-reflow was determined by using appropriate statistical program.

Results: There was a correlation between elevated CRP and WBC counts with increased inflammatory burden and increased size of infarct. Low levels of magnesium in the bloodstream were associated with the risk of coronary vasospasm and increased risk of ventricular arrhythmias. High CRP, high WBC and low magnesium were independently associated with no-reflow after primary PCI, with significant increases in risk for no-reflow in patients with all three of these risk factors.

Conclusion: No-reflow is predictable in AMI patients treated with PCI by the use of simple, inexpensive, and readily available tests such as CRP, WBC count, and serum magnesium levels. Early detection of those at risk can inform clinical care and help to implement preventive interventions.