The Predictors of No-Reflow Phenomenon after Primary Angioplasty for Acute Myocardial Infarction

Ata  Firouzi; Kamran Aeinfar; Hossein  Shahsavari; Hamidreza  Sanati; Farshad  Shakerian; Reza  Kiani; Ali  Zahed Mehr

International Cardiovascular Research Journal

The Official Annually Journal of Cardiovascular Research Center, Shiraz University of Medical Sciences

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The Predictors of No-Reflow Phenomenon after Primary Angioplasty for Acute Myocardial Infarction

Author(s):

Ata Firouzi^1,*,

Kamran Aeinfar²,

Hossein Shahsavari²,

Hamidreza Sanati¹,

Farshad Shakerian¹,

Reza Kiani¹,

Ali Zahed Mehr¹

1Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

2Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

International Cardiovascular Research Journal:Vol. 10, issue 3; e10162

Published online:Sep 15, 2016

Article type:Review Article

Received:Jul 11, 2015

Accepted:Jan 11, 2016

How to Cite:Firouzi A, Aeinfar K, Shahsavari H, Sanati H, Shakerian F, et al. The Predictors of No-Reflow Phenomenon after Primary Angioplasty for Acute Myocardial Infarction.Int Cardiovasc Res J.2016;10(3):e10162.

Abstract

Background:
No-reflow phenomenon is a serious complication of primary Percutaneous Coronary Intervention (PCI), which may increase the risk of progressive myocardial damage, profound left ventricular dysfunction, and death.
Objectives:
This study aimed to investigate the incidence of no-reflow phenomenon and its clinical, para-clinical, and angiographic determinants in patients who underwent primary PCI for ST Elevation Myocardial Infarction (STEMI).
Patients and Methods:
This non-randomized prospective cohort study was conducted on 397 patients in a cardiovascular tertiary care center in Tehran, Iran from April 2012 to April 2014. The inclusion criteria of the study were presenting with acute STEMI of ≤ 12 h duration or having admitted between 12 and 24 hours after onset with symptoms and signs of ongoing ischemia. The participants underwent standard coronary angiography. No-reflow phenomenon was defined as a Thrombolysis In Myocardial Infarction (TIMI) flow ≤ 2 and no presence of spasm, distal embolization, or dissection after completion of the procedure. The association between no-reflow and its determinants was assessed by chi-square, student’s t-test, or Mann–Whitney U test. Logistic regression models were also used for multivariate analysis. P values < 0.05 were considered to be statistically significant.
Results:
The participants’ mean (SD) age was of 59 (12.2) years and female/male ratio was 83/314. The incidence of no-reflow phenomenon was 63 (15.9%). Besides, the results of multivariate analysis showed that only thrombus burden, lesion length, time to reperfusion, and type of occlusion had an adjusted association with this phenomenon.
Conclusions:
The study results suggested that no-reflow phenomenon after primary PCI would be predictable. Thus, preventive measures, such as using distal protective devices or administration of platelet glycoprotein IIb/IIIa antagonists, are advised to be used in high-risk patients.

Keywords

Myocardial Infarction

Angioplasty

Balloon

No-Reflow Phenomenon

Myocardial Reperfusion

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