Predictors and Outcomes of No-Reflow Phenomenon Following Primary Percutaneous Intervention for ST Elevation Myocardial Infarction

Background: The term no-reflow was first used by Majno and colleagues in the setting of cerebral ischemia in 1967. This phenomenon was initially described by Krug et al. during induced myocardial infarction in the canine model in1966 and again by Kloner et al. in1974 in which it occurred for 90 min after temporary epicardial coronary artery occlusion. Myocardial tracers, such as carbon black or thioflavin S were injected to document uniform flow distribution across the myocardial tissue after 40 min of occlusion. After 90 min, persistent subendocardial perfusion defects were seen with no-reflow. Objectives: Detection, prevention, and treatment of no-refloware likely to have an important impact on the outcome of PPCI. Here we propose possible personalized forms of prevention and treatment, on the basis of the notion that no-reflow is a dynamic process characterized by multiple pathogenetic components. Methods: We analyzed a total of 120 consecutive patients with STEMI and treated with PPCI between 1st of November 2016 to July 2017 at our institution. The patients are divided into two groups according to the final TIMI flow after the primary PCI, and the incidence of in hospital MACE as follows: Group A: had a normal flow after the PPCI and did not have in hospital MACE; Group B: had either no reflow after the PPCI or experienced in hospital MACE. Results: The incidence of no reflow was 13.2%, and in hospital MACE was 5%, with cardiac death as the predominant form of in hospital MACE. The group with no reflow or in hospital MACE showed significantly older age, longer door to balloon time, higher levels of admission RPG, N/L ratio, and MPV. Compared to the literature, Egyptian patients had more diabetes mellitus, more dyslipidaemia, longer door to balloon time. Conclusions: Older patient age, longer door to balloon time, admission hyperglycemia, higher admission N/L ratio, MPV, longer reperfusion time, elevated level of high sensitive CRP on admission, and markedly elevated levels of CKMB, large thrombus burden LTB, are useful predictive factors for the occurrence of no reflow post PPCI, and/or in hospital MACE.