Predictors of No-Reflow Phenomenon in Primary Percutaneous Coronary Intervention among Patients with Acute Myocardial Infarction

Abstract

Background: The no-reflow phenomenon, characterized by the failure to restore myocardial blood flow after reopening an occluded artery in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI), has significant implications for patient prognosis. Understanding the predictors of no-reflow is crucial for improving clinical outcomes in this high-risk population. Objective: This study aims to identify the predictors of the no-reflow phenomenon in patients with AMI undergoing PCI and to assess their impact on the efficacy of the intervention. Methods: Conducted at Lady Reading Hospital's Cardiology Department, this descriptive study retrospectively analyzed 120 AMI patients treated with PCI from May 2023 to November 2023. Ethical approval was obtained, and the study conformed to the Declaration of Helsinki. The diagnosis of AMI was based on clinical symptoms and electrocardiographic findings. Experienced cardiologists performed PCI, and no-reflow was defined using Thrombolysis in Myocardial Infarction (TIMI) flow grades and Myocardial Blush Grade (MBG). Data were analyzed using SPSS Version 25, focusing on demographic variables, clinical presentations, and procedural details to identify predictors of no-reflow. Results: Out of 120 patients, 70.8% were male. The incidence of no-reflow was 22.5%. Significant predictors of no-reflow included systolic blood pressure < 100 mmHg (51.9% in no-reflow vs. 28.0% in normal flow, P=0.02), diabetes (59.3% vs. 34.4%, P=0.02), hypertension (77.8% vs. 31.2%, P=0.0001), and history of cardiovascular disease (11.1% vs. 2.2%, P=0.04). Conclusion: The study identified diabetes, hypertension, low systolic blood pressure, and a history of cardiovascular disease as significant predictors of the no-reflow phenomenon in AMI patients undergoing PCI. These findings highlight the importance of identifying and managing these risk factors to enhance the success of PCI and improve patient outcomes.