Original Research

DOI: http://doi.org/10.31928/2305-3127-2018.3.1625 

«No-reflow» phenomenon and risk factors associated with its development after primary percutaneous coronary interventions in patients with ST elevation myocardial infarction

V.І. Tseluyko, M.M. Doloh, O.A. Leonenko 

Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine

The aim – to determine the incidence of the «no-reflow» phenomenon (NRP) after percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction and to investigate clinical, anamnestic and angiographic risk factors associated with development of NRP.

Materials and methods. 105 patients with ST elevation myocardial infarction, reported between January 2014 and September 2017, were studied. The age of the patients was 36 to 85 years, mean age 60.4 ± 2.03 years. PCI was performed immediately after the diagnosis of STEMI, an average 7.6 ± 1.2 hours after onset of the first symptoms. NRP was determined after recanalization of the infarct-associated coronary artery as the absence of optimal myocardial perfusion using MBG (Myocardial Blush Grade, MBG ≤ 2) scale. All patients after PCI, depending on the angiographic pattern, were divided into two groups: patients with NRP were assigned to the main group, n = 18 (17.1 %), patients whose angiographic data met the criteria for successful PCI, were appropriately allocated to the control group, n = 87 (82.9 %).

Results. Analysis of the groups showed that the incidence of NRP was significantly higher in patients with time «pain – balloon» more than 12 hours (OR 4.8, 95 % CI 1.6–14.1, p < 0.05), acute heart failure of grade 3–4 according to Killip (OR 8.6, 95 % CI 2.44–30.26, p < 0.05), circular infarction (OR 8.5, 95 % CI 1.31–55.24, p < 0.05), diameter of the infarct-related artery > 3 mm (OR 4.69, 95 % CI 1.59–13.85, p < 0.01), and the available «cut-off» occlusion (OR 12.69, 95 % CI 3.79–40.19, p < 0.001), while patients with time «pain – balloon» less than 6 hours had significantly fewer cases of NRP development (OR 0.13, 95 % CI 0.03–0.618, p < 0.05).

Conclusions. The «no-reflow» phenomenon after urgent PCI occurs in a significant (17.1 %) number of STEMI patients against background of standard drug therapy and is associated with an ischemia duration of more than 12 hours, infarct-related artery diameter more than 3 mm, circular infarction and angiographic evidence indicating large amount of atherothrombotic masses in infarct-related artery.

Key words: «no-reflow» phenomenon, coronary angiography, percutaneous coronary intervention, ST segment elevation acute myocardial infarction.