Assessment of the Clinical and Procedural Predictive Factors ofNo-Reflow Phenomenon Following Primary Percutaneous CoronaryIntervention

AbstractBackground: Angiographic no-reflow phenomenon, areduced coronary antegrade flow (TIMI flow grade <-2) withoutmechanical obstruction after recanalization, predicts poor LVfunctional recovery and survival in the early phase of STEMI.Although the predisposing factors of the no-reflow phenom-enon were investigated, there is little data about clinical andprocedural predictors of this phenomenon.Aim of Study: The aim of this study was to evaluate theclinical and procedural predictive factors of no-reflow phe-nomenon following primary PCI.Patients and Methods: The present study was conductedon 145 patients admitted with STEMI and treated with 1ryPCI at Cardiovascular Medicine Department, Tanta UniversityHospitals within 6 months from June 2016 to December 2016.Patients were divided into 2 groups according to no-reflowphenomenon. Group I: 29 patients with no reflow phenomenon.Group II: 116 patients without no reflow phenomenon. Allpatients were subjected to an informed consent, history takingincluding personal history, risk factors including Hypertension (HTN), Diabetes Mellitus (DM), smoking, renal impairment.family history of premature coronary artery disease, pastmedical history of prior Myocardial Infarction (MI), Percuta-neous Coronary Intervention (PCI) or Coronary Artery BypassGraft (CABG), medications history, clinical examinationincluding vital signs, Body Mass Index (BMI), signs of heartfailure/hemodynamic instability according to Killip classifi-cation, signs of co-morbidities including renal/hepatic insuf-ficiency, diabetes. Local cardiac examination, twelve leadssurface ECG, echocardiography, blood sampling includingserum cardiac biomarkers, complete blood count, lipid profile (total cholesterol, HDL, LDL, triglycerides), random bloodsugar on admission, serum urea & creatinine on admission.Patients were subjected to diagnostic coronary angiographyand primary PCI.Results: The study demonstrated that there was a signif-icant association between angiographic no-reflow and old age, female gender, history of DM, prior MI, increased timeto reperfusion, higher Killip class, decreased LV ejectionfraction, increased blood CKMB, increased blood glucose,increased blood creatinine, the use of inotropes, initial TIMIflow grade 0, high thrombus burden and stenting with ballonpredilatation.Conclusion: The occurrence of no-reflow phenomenonafter primary PCI can be predicted using simple clinical,laboratory, angiographic and procedural features which includeold age, female gender, history of DM, prior MI, increasedtime to reperfusion, higher Killip class, decreased LV ejectionfraction, increased blood CKMB, increased blood glucose,increased blood creatinine, the use of inotropes, initial TIMIflow grade 0, high thrombus burden and stenting with ballonpredilatation.