PREDICTORS AND OUTCOMES OF NO-REFLOW PHENOMENON FOLLOWING PRIMARY PERCUTANEOUS INTERVENTION FOR ST ELEVATION MYOCARDIAL INFARCTION

Ahmed A. Rozza*, MD, Yosry Z. Elzohery, MD, Ahmed M. Fahmy, MD, Mohamed A. Abo Ahmed, MD and Mohamed E. Elgizy, M. SC.

ABSTRACT

Objective: After acute myocardial infarction (AMI), the immediate therapeutic goal is to establish patency of the infarct-related artery. The successful restoration of epicardial coronary artery patency, however, does not necessarily translate into improved tissue perfusion. The ‘no-reflow’ phenomenon, characterized by inadequate flow at tissue level despite a reopened epicardial coronary artery after percutaneous coronary intervention. Although uncommon side effects of percutaneous coronary intervention, no-reflow phenomenon is considered a critical complication if not reversed, causes a high rate of mortality and morbidity.[1] Methods: The study population consisted of 120 consecutive patients presented with STEMI and treated with PPCI during the period from the 1st of November 2016 to July 2017 in Al-Azhar Main University Hospital, and the national heart institute (NHI), Giza, Egypt.All patients were subjected to informed consent, detailed history taking, clinical evaluation, ECG analysis and laboratory investigations (including admission CBC, RPG, lipid profile). Door to balloon time computed and given in hours. Coronary angiography (showing the initial TIMI flow) and PCI procedure (whether POBA, BMS, or DES were used, and the occurrence of no reflow phenomenon) were also documented. Patients were put under observation to detect the occurrence of any in-hospital MACE or other hemodynamic complications. 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, than patients studied in Europe, and Japan. Stenting in primary coronary intervention in our country was the usual practice according to ESC guidelines. Conclusion: 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.

Keywords: Acute myocardial infarction, No-reflow phenomenon, Percutaneous coronary intervention, Thrombus.