Impact of Total Ischemic Time on No Reflow Phenomenon

Abstract

Background: Ischemic heart disease, particularly ST-segment elevation myocardial infarction (STEMI), remains a major cause of morbidity and mortality globally. Despite advancements in primary percutaneous coronary intervention (PPCI), the no-reflow phenomenon, characterized by inadequate myocardial reperfusion despite successful vessel recanalization, continues to pose significant challenges, affecting clinical outcomes adversely. Objective: This study aims to investigate the relationship between total ischemic time and the incidence of the no-reflow phenomenon in STEMI patients undergoing PPCI, to identify potential strategies for improving therapeutic outcomes. Methods: Conducted at Hayatabad Medical Complex, Peshawar, this retrospective cohort study included 160 STEMI patients treated over eight months (February to October 2022). We collected data on demographic characteristics, clinical presentation, and outcomes. Inclusion criteria were patients over 18 years, undergoing PPCI within 12 hours of symptom onset, without prior MI, severe bleeding disorders, or previous significant revascularization. Statistical analysis was performed using SPSS 25.0, considering P ≤0.05 as statistically significant. Results: The average total ischemic time was significantly longer in patients experiencing no-reflow (Group I, 7.91 hours) compared to those with normal reperfusion (Group II, 3.41 hours) (P=0.001). Group I also showed higher rates of cardiogenic shock (17.6% vs. 6.8%, P=0.012) and reinfarction (11.8% vs. 2.9%, P=0.010). Mortality was significantly higher in Group I (5.8% vs. 1.9%, P=0.020). Conclusion: Longer total ischemic time is associated with an increased risk of the no-reflow phenomenon and poorer clinical outcomes in STEMI patients. Reducing ischemic time could be crucial in improving reperfusion success and reducing complications post-PPCI.