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

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

doi:10.3390/jcm9092956

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.

Highlights

The “no-reflow” phenomenon (NRP) represents the myocardial tissue hypoperfusion after relief of occlusion, despite having an opened and patent epicardial coronary artery
We considered as an NRP patient any subject with ST-elevation myocardial infarction (STEMI) and thrombolysis in myocardial infarction (TIMI) flow degree ≤2 and a degree of myocardial blush grade (MBG) ≤2 during angiography procedure
If the TIMI flow and MBG improved after administering vasodilators, we considered it transient NRP or, if not, as permanent NRP

Summary

Introduction

The “no-reflow” phenomenon (NRP) represents the myocardial tissue hypoperfusion after relief of occlusion, despite having an opened and patent epicardial coronary artery. It is essential to understand the pathophysiology of this phenomenon, to prevent and treat it early and to avoid permanent myocardial damage and poorer prognosis. The steps in addressing this pathology consist of knowing the preventive measures to avoid the consequences of a possible failure at this stage, as well as a good knowledge of PNR diagnostic methods and treatment possibilities. Following an acute ST-elevation myocardial infarction (STEMI), it is essential to achieve the reperfusion of the culprit artery as soon as possible, with the resumption of optimal blood flow. Primary percutaneous intervention (PPCI) is the most indicated reperfusion option in patients with acute STEMI, having an approximately 95% success rate in opening the occluded coronary artery [1]. PPCI is more effective and decreases mortality [2]

Results

Discussion

Conclusion