No-Reflow after PPCI-A Predictor of Short-Term Outcomes in STEMI Patients

Larisa Renata Pantea-Roșan, Vlad Alin Pantea, Simona Bungau, Delia Mirela Tit, Tapan Behl, Cosmin Mihai Vesa, Cristiana Bustea, Radu Dumitru Moleriu, Marius Rus, Mircea Ioachim Popescu, Vladiana Turi, Camelia Cristina Diaconu, Larisa Renata Pantea-Roșan, Vlad Alin Pantea, Simona Bungau, Delia Mirela Tit, Tapan Behl, Cosmin Mihai Vesa, Cristiana Bustea, Radu Dumitru Moleriu, Marius Rus, Mircea Ioachim Popescu, Vladiana Turi, Camelia Cristina Diaconu

Abstract

The no-reflow phenomenon following primary percutaneous coronary intervention (PPCI) in acute ST-elevation myocardial infarction (STEMI) patients is a predictor of unfavorable prognosis. Patients with no-reflow have many complications during admission, and it is considered a marker of short-term mortality. The current research emphasizes the circumstances of the incidence and complications of the no-reflow phenomenon in STEMI patients, including in-hospital mortality. In this case-control study, conducted over two and a half years, there were enrolled 656 patients diagnosed with STEMI and reperfused through PPCI. Several patients (n = 96) developed an interventional type of no-reflow phenomenon. One third of the patients with a no-reflow phenomenon suffered complications during admission, and 14 succumbed. Regarding complications, the majority consisted of arrhythmias (21.68%) and cardiogenic shock (16.67%). The anterior localization of STEMI and the left anterior descending artery (LAD) as a culprit lesion were associated with the highest number of complications during hospitalization. At the same time, the time interval >12 h from the onset of the typical symptoms of myocardial infarction (MI) until revascularization, as well as multiple stents implantations during PPCI, correlated with an increased incidence of short-term complications. The no-reflow phenomenon in patients with STEMI was associated with an unfavorable short-term prognosis.

Keywords: acute myocardial infarction (MI); no-reflow phenomenon (NRP); primary percutaneous coronary intervention (PPCI); thrombolysis in myocardial infarction (TIMI) risk score.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart describing the way of patient selection (STEMI: ST-segment elevation myocardial infarction, PCI: percutaneous coronary intervention).
Figure 2
Figure 2
The prevalence of complications depending on the culprit artery and STEMI for NRP+ group Legend: RCA: right coronary artery (n = 27); LAD: left anterior descending artery (n = 64); STEMI: ST-segment elevation myocardial infarction (anterior STEMI: n = 65 and inferior STEMI: n = 31).
Figure 3
Figure 3
The dependence between the number of complications and the number of dead patients in the NRP+ group.
Figure 4
Figure 4
The association between the number of complications and the number of dead patients in the NRP+ group.
Figure 5
Figure 5
Pathophysiology mechanisms in the no-reflow phenomenon following primary percutaneous coronary intervention in ST-elevation myocardial infarction patients [47].

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