What is the prevalence of no-reflow following percutaneous coronary intervention (PCI) for the treatment of STEMI and how does it affect outcomes?

Updated: Nov 27, 2019
  • Author: George A Stouffer, III, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

From a procedural perspective, because primary PCI involves a thrombotic plaque, there is a potential for thrombotic complications including no-reflow and distal embolization. In these patients, there is some evidence that stenting plus GPIIb/IIIa inhibition will improve outcomes, as well as reduce target vessel revascularization and MI rates.

An analysis of 291,380 patients with AMI who underwent PCI of native coronary artery stenoses showed that no-reflow developed in 2.3%. Risk factors included older age, STEMI, prolonged interval from symptom onset to admission, and cardiogenic shock. [57] Angiographic factors associated with no-reflow included longer lesion length, class C lesions, bifurcation lesions, and impaired preprocedural TIMI flow. No-reflow was associated with greater in-hospital mortality. The authors concluded that no-reflow, though uncommon, is associated with adverse clinical outcomes.

Of interest has been the recognition that failure of complete reperfusion based on myocardial blush grade or incomplete ST-segment resolution (~50 % of patients with primary PCI) is associated with poorer outcomes despite normal epicardial flow. Efforts to reduce distal embolization using several strategies have been developed. Despite early promise from mechanical aspiration devices, intracoronary GPIIb/IIIa inhibitor use, and stent-based exclusion (Mesh Guard), none of these approaches has been proved to offer definitive benefit.


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