Incidence and outcome of no flow after primary percutaneous coronary intervention in acute myocardial infarction

Abstract


 Background: Mechanical revascularization of the infarct-related artery (IRA)
 is the most effective treatment modality in ST-segment elevation myocardial
 infarction (STEMI).No flow occurs in ∼8.8-10% of cases of primary
 percutaneous coronary intervention(PCI) in STEMI patients. Our aim was to study 
 actual incidence and outcome of no flow patients.
 Methods: Five hundred and eighty primary PCI patients
 were studied over a period of two years i.e. January 2016 to December 2017.
 Drug eluting stents were used in all cases. Majority of our patients(>90%) came 6
 hours after onset of chest pain. There were many patients where there was 
 no flow even after mechanical thrombus aspiration and pharmacological
 vasodilator therapy. We have studied primary outcome(mortality) of no flow in
 those patients. 
 Results: There were 44 cases of no flow in our
 series(7.75%). Left anterior descending artery(LAD )was involved in eighteen
 patients. Right coronary artery(RCA) was culprit in twenty four cases. Only
 two cases were seen in LCX territory. One month mortality rate in no flow group
 was 50% and 6.25% in successful recanalization group. One year mortality was
 12.5% in successful recanalization group and 66% in no flow group.
 Conclusion: Refractory no flow during primary PCI in STEMI is associated
 with high mortality and morbidity. There is no established strategy to solve
 this phenomenon.