Predictors of the no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction due to stenotic coronary artery disease
DOI:
https://doi.org/10.14739/2310-1210.2025.2.320492Keywords:
acute myocardial infarction, STEMI, percutaneous coronary intervention, no-reflow phenomenon, risk factorsAbstract
Aim. To identify modifiable and non-modifiable risk factors for no-reflow syndrome in ST-segment elevation myocardial infarction (STEMI) patients undergoing reperfusion by balloon angioplasty.
Materials and methods. We analyzed 392 patients with STEMI who underwent percutaneous coronary intervention (PCI). The patients were divided into 2 groups based on the presence of no-reflow syndrome. Clinical data, laboratory results and instrumental findings were compared between the groups.
Results. A higher proportion of women has been observed among no-reflow patients compared to normal-flow group (33 % versus 22 %, p < 0.05). A lower hemoglobin level has been found in the study group as compared to that in the control group: 132 g/L and 136 g/L, respectively (p < 0.05). However, the same proportion of individuals with anemia has been documented in both groups (p = 0.79). Patients with no-reflow syndrome had lower glomerular filtration rate (GFR) compared to those in the normal-flow group – 61.1 mL/min/1.73 m2 versus 67.9 mL/min/1.73 m2 (p < 0.05). Additionally, GFR <60 mL/min/1.73 m2 has been more common in the study group (48 %) than in the control group (35 %). Lesion types of an infarct-related artery in patients with no-reflow have been presented significantly more often as acute occlusion (78 % versus 65 %, p < 0.05) or thrombotic occlusion / subocclusion (6 % versus 1 %, p < 0.05). In the cases of impeded distal blood circulation during PCI, thrombus extraction was performed in 9 % of patients, compared to only 2 % in the normal blood flow group (p < 0.05). Female sex (OR 1.71 95 % CI 1.01–2.87), thrombus extraction (OR 4.24 95 % CI 1.49–12.05) and a patient belonging to the GFR <60 mL/min/1.73 m2 category (OR 1.66 95 % CI 1.03–2.69) have been identified as the risk factors increasing the chances for developing no-reflow.
Conclusions. Female sex represents a non-modifiable risk factor for the development of no-reflow phenomenon. GFR <60 mL/min/1.73 m2 is a significant modifiable risk factor. Characteristics of the infarct-related artery lesion, such as acute occlusion or thrombotic occlusion / subocclusion, are associated with an increased risk of no-reflow.
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