Abstract
Background: Primary percutaneous coronary intervention (PCI) is the preferred method of ST-segment elevation acute myocardial infarction (STEMI) management but no-reflow phenomenon is one of its major complications that affects patient's outcome. Objective: Identification of possible clinical, angiographic and procedural predictors for no-reflow in patients with AMI after primary percutaneous coronary intervention (PCI). Methods: A total of hundred patients with AMI who had been treated by primary PCI at the National heart institute (NHI) and cardiology department, Menoufia University hospital were enrolled in this study, according to thrombolysis in myocardial infarction (TIMI) flow grade, patients were divided into a reflow group (TIMI 3) and a no-reflow group (TIMI ≤ 2). The clinical, angiographic and procedural data were compared between both groups. Discussion: Sixteen patients (16%) developed no-reflow phenomenon after primary PCI. Statistical analysis showed that time from onset to reperfusion, low initial TIMI flow grade, high thrombus burden, long lesion length and large reference luminal diameter were correlated with no-reflow (P < 0.05 for all) and were considered to be independent predictors of no-reflow. Conclusion: The occurrence of no-reflow after primary PCI for acute myocardial infarction can be predicted by certain clinical, angiographic and procedural features.
Highlights
The treatment of ST-segment elevation myocardial infarction (STEMI) is directed toward rapid and proper restoration of normal blood flow in the infarct related artery (IRA) to decrease ischemic damage to the myocardium as early as possible [1]
Total of hundred acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention (PCI) between January 2016 and June 2016 at the National heart institute (NHI) and cardiology department, Menoufia University hospital were enrolled in the study
Standard coronary angiograms was carried out through the femoral approach with assessment of the following angiographic data: Identification of the IRA, angiographic features of the culprit lesion, thrombolysis in myocardial infarction (TIMI) flow grade before and after primary PCI, target lesion length, reference luminal diameter, type of total occlusion if present, type of subtotal occlusion if present, lesion location, thrombus burden degree was scored according to the thrombus scoring system proposed by the TIMI group, it was classified as mild if the TIMI thrombus grade was class 0 or 1, moderate if the TIMI thrombus grade was class 2 or 3, and high if the TIMI thrombus grade was more than class 3 [6]
Summary
The treatment of ST-segment elevation myocardial infarction (STEMI) is directed toward rapid and proper restoration of normal blood flow in the infarct related artery (IRA) to decrease ischemic damage to the myocardium as early as possible [1]. Patency of the infarct-related artery does not always mean restoration of normal coronary blood flow as in certain group of patients epicardial coronary artery reperfusion is achieved but without myocardial reperfusion after primary PCI, this condition is known as no-reflow [3]. Patients who develop this phenomenon are subjected to more myocardial damage and higher risk of cardiac morbidity and mortality [4]. Objective: Identification of possible clinical, angiographic and procedural predictors for no-reflow in patients with AMI after primary percutaneous coronary intervention (PCI). Conclusion: The occurrence of no-reflow after primary PCI for acute myocardial infarction can be predicted by certain clinical, angiographic and procedural features
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