Incidence and Predictors of No Reflow Phenomenon in Patient Undergoing Primary Percutaneous Coronary Intervention

Objective: To evaluate the incidence, clinical and angiographic predictors of no reflow phenomenon in patient undergoing primary percutaneous coronary intervention (PCI).

Methods: This prospective observational cross-sectional study was carried out on 748 patients who underwent primary coronary angioplasty after acute ST- Segment Elevation Myocardial Infarction (STEMI). Patients were subdivided in to two groups: Group I: (case group) patients with no-reflow phenomenon (NRP) in the absence of dissection, thrombus, spasm or high-grade residual stenosis and group II: (Control group) one consecutive STEMI patient after each case, with TIMI flow III after primary PCI. All patients were subjected to clinical and laboratory examination, electrocardiogram (ECG), echocardiography (ECHO) and PCI.

Results: 22.9% of patients had no-reflow; 10 % had persistent no reflow and 12.9% had transient no reflow. Multivariate analyses identified that age (OR=1.417, 95% CI 1.319–1.521), diabetes mellitus (DM) (OR=10.110, 95% CI 3.950–25.880), hypertension (HTN) (OR=0.326, 95% CI 0.142–0.752), total ischemia time ≥6 hours (OR=60.511, 95% CI 24.973–146.618), SBP<90 mmHg (OR=0.238, 95% CI 0.091–0.621) , lesion length ≥20 mm(OR=16.182, 95% CI 5.008–52.287) , high thrombus burden (thrombus grade ≥4) (OR=2.914, 95% CI 1.018–8.338), balloon pre dilatation (OR=0.272, 95% CI 0.093–0.791), stent length ≥20 mm(OR=7.709, 95%CI 33.346–17.758), balloon post dilatation (OR=5.885, 95% CI 2.571–13.474), CRP (OR=1.016, 95% CI 1.002–1.030) were the independent predictors of the no-flow phenomenon.

Conclusions: Clinical and laboratory predictors on admission were associated with higher percentage of no-reflow phenomenon. while angiographic predictors could independently predicts no-reflow after Primary PCI.