Predictors of no-reflow in patients undergoing primary percutaneous coronary intervention. Thrombus aspiration was protective.

Abstract

Primary percutaneous coronary intervention (P-PCI) is the best available reperfusion strategy in patients with acute ST-segment elevation myocardial infarction (STEMI).1 However establishing myocardial reperfusion by P-PCI is associated with a serious complication called no reflow (NR); defined as final Thrombolysis in myocardial infarction (TIMI) flow <3 or TIMI 3 flow with TIMI myocardial blush grade (TMBG) 0 or 1 in absence of mechanical obstruction.2 NR is considered to be an under-reported complication with a low incidence (1–3%) in large registries, based on TIMI flow grade, MBG and ST resolution.3 Modern more sensitive methods of assessing NR and microcirculatory dysfunction, including myocardial contrast echocardiography (MCE) and cardiac magnetic resonance imaging (CMR), have recorded a higher incidence (10–30%).4 Although these techniques have greater accuracy for detecting post-PCI suboptimal reperfusion, TIMI flow grade is the easiest and most commonly used method of evaluating P-PCI success.5, 6 The objective of the present trial was to identify the prevalence of NR in patients with STEMI undergoing P-PCI in the current era and its predictors with short term outcome.