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Predictors and outcomes of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Tasar, Onura; Karabay, Arzu K.b; Oduncu, Vecihb; Kirma, Cevatb

doi: 10.1097/MCA.0000000000000726

Aim The aim of this study is to identify the predictors of angiographic no-reflow development in patients who underwent primary percutaneous coronary intervention and to investigate the long-term (median follow-up time=59 months) clinical endpoints.

Patients and methods We retrospectively evaluated 3205 patients (824 females, mean age: 58.6 years) with acute myocardial infarction (ST-segment elevation myocardial infarction) admitted within the first 12 h of chest pain and treated with primary percutaneous coronary intervention between January 2006 and January 2010. The patients were divided into angiographic no-reflow [final Thrombolysis In Myocardial Infarction (TIMI)<3 flow] (n=324) and reflow (final TIMI 3) (n=2881) groups.

Results On multivariate logistic regression analysis age [odds ratio (OR)=1.02, 95% confidence interval (CI): 1.00–1.04, P=0.003], Killip class≥2 (OR=1.99, 95% CI: 1.30–3.04, P=0.002), pain-to-balloon time more than 4 h (OR=3.98, 95% CI: 2.50–6.32, P<0.001), baseline TIMI≤1 flow (OR=2.55, 95% CI: 1.05–6.22, P=0.038), lesion length of at least 15 mm (OR=4.31, 95% CI: 2.89–6.41, P<0.001), reference vessel diameter of at least 3.5 mm (OR=2.83, 95% CI: 1.87–4.27, P<0.001), cutoff occlusion pattern (OR=1.93, 95% CI: 1.03–3.62, P=0.04), and SYNTAX score of at least 19 (OR=1.76, 95% CI: 1.1.23–3.07, P<0.001)] were found as significant predictors for the development of no-reflow phenomenon. In no-reflow patients, in-hospital mortality (10.8 vs. 2.9%), heart failure (32.1 vs. 8.7%), and severe arrhythmias (23.1 vs. 9.3%) were significantly more common (P<0.001), for all. In the long-term follow-up, death (33.3 vs. 13.4%, P<0.001), advanced heart failure (12.5 vs. 5.4%, P<0.001), and stroke (3.5 vs. 1.7%, P=0.035) rates were significantly higher in the no-reflow group.

Conclusion The no-reflow predictors that were identified in this study might be useful in the determination of the patients who could benefit from aggressive pharmaco-invasive therapy. Development of no-reflow is associated with both in-hospital and long-term very high morbidity and mortality rates.

aDepartment of Cardiology, Elazig Research and Education Hospital, Elazig

bDepartment of Cardiology, Kosuyolu Heart Center, Istanbul, Turkey

Correspondence to Onur Tasar, MD, No. 74, Inonu Street, Elazig 23200, Rizaiye Province, Turkey Tel: +90 424 238 10000; fax: +90 424 459 1000; e-mail:

Received September 15, 2018

Received in revised form January 14, 2019

Accepted January 26, 2019

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