Predictors of the no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction due to stenotic coronary artery disease

Authors

DOI:

https://doi.org/10.14739/2310-1210.2025.2.320492

Keywords:

acute myocardial infarction, STEMI, percutaneous coronary intervention, no-reflow phenomenon, risk factors

Abstract

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.

Author Biographies

O. O. Khaniukov, Dnipro State Medical University

MD, PhD, DSc, Professor, Head of the Department of Internal Medicine No. 3

L. V. Sapozhnychenko, Dnipro State Medical University

MD, PhD, Associate Professor, Department of Internal Medicine No. 3

O. V. Smolianova, Dnipro State Medical University

MD, PhD, Assistant, Department of Internal Medicine No. 3

I. D. Bashmakov, Dnipro State Medical University

6th-year student

References

Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc Care. 2024;13(1):55-161. doi: https://doi.org/10.1093/ehjacc/zuad107

d'Entremont MA, Alazzoni A, Dzavik V, Sharma V, Overgaard CB, Lemaire-Paquette S, et al. No-reflow after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction: an angiographic core laboratory analysis of the TOTAL Trial. EuroIntervention. 2023;19(5):e394-e401. doi: https://doi.org/10.4244/EIJ-D-23-00112

Ministry of Health of Ukraine. Unifikovanyi klinichnyi protokol ekstrenoi, pervynnoi, vtorynnoi (spetsializovanoi), tretynnoi (vysokospetsializovanoi) medychnoi dopomohy ta kardioreabilitatsii "Hostryi koronarnyi syndrom bez elevatsii sehmenta ST" [Unified clinical protocol for emergency, primary, secondary (specialized), tertiary (highly specialized) medical care and cardiac rehabilitation "Acute coronary syndrome with ST segment elevation". Order dated 2021 Sep 15, No. 1957] [Internet]. 2021 [cited 2025 Jan 3]. Ukrainian. Available from: https://zakon.rada.gov.ua/rada/show/v1957282-21?lang=en#Text

Sarkar A, Grigg WS, Lee JJ. TIMI grade flow. StatPearls, Treasure Island (FL): StatPearls Publishing; 2024. http://www.ncbi.nlm.nih.gov/books/NBK482412

Hruzieva TS, Lekhan VM, Ohniev VA, Haliienko LI, Kriachkova LV, Palamar BI, et al. [Biostatistics: textbook]. Vinnytsia, Ukraine: Nova Knyha; 2020. Ukrainian.

Baaten C, Vondenhoff S, Noels H. Endothelial Cell Dysfunction and Increased Cardiovascular Risk in Patients With Chronic Kidney Disease. Circ Res. 2023;132(8):970-92. doi: https://doi.org/10.1161/CIRCRESAHA.123.321752

Ndrepepa G, Kastrati A. Coronary No-Reflow after Primary Percutaneous Coronary Intervention-Current Knowledge on Pathophysiology, Diagnosis, Clinical Impact and Therapy. J Clin Med. 2023;12(17):5592. doi: https://doi.org/10.3390/jcm12175592

Namazi M, Mahmoudi E, Safi M, Jenab Y, Vakili H, Saadat H, et al. The No-reflow Phenomenon: Is it Predictable by Demographic factors and Routine Laboratory Data? Acta Biomed. 2021 Nov 3;92(5):e2021297. doi: https://doi.org/10.23750/abm.v92i5.10053

Yu Y, Wu Y, Wu X, Wang J, Wang C. Risk Factors for No-Reflow in Patients with ST-Elevation Myocardial Infarction Who Underwent Percutaneous Coronary Intervention: A Case-Control Study. Cardiol Res Pract. 2022;2022:3482518. doi: https://doi.org/10.1155/2022/3482518

El Khoudary SR, Nasr A. Cardiovascular Disease in Women: Does Menopause Matter? Curr Opin Endocr Metab Res. 2022;27:100419. doi: https://doi.org/10.1016/j.coemr.2022.100419

Savic L, Mrdovic I, Asanin M, Stankovic S, Lasica R, Krljanac G, et al. The Impact of Kidney Function on the Slow-Flow/No-Reflow Phenomenon in Patients Treated with Primary Percutaneous Coronary Intervention: Registry Analysis. J Interv Cardiol. 2022;2022:5815274. doi: https://doi.org/10.1155/2022/5815274

Bamarinejad F, Kermani-Alghoraishi M, Soleimani A, Roohafza H, Yazdekhasti S, Azarm M, et al. Clinical, laboratory, and procedural predictors of slow flow/no reflow phenomenon after emergency percutaneous coronary interventions in ST-elevated myocardial infarction. Egypt Heart J. 2024;76(1):146. doi: https://doi.org/10.1186/s43044-024-00577-0

Yang L, Cong H, Lu Y, Chen X, Liu Y. Prediction of no-reflow phenomenon in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Medicine (Baltimore). 2020;99(26):e20152. doi: https://doi.org/10.1097/MD.0000000000020152

Satti Z, Omari M, Bawamia B, Cartlidge T, Egred M, Farag M, et al. The Use of Thrombectomy during Primary Percutaneous Coronary Intervention: Resurrecting an Old Concept in Contemporary Practice. J Clin Med. 2024;13(8):2291. doi: https://doi.org/10.3390/jcm13082291

Januszek R, Siudak Z, Malinowski KP, Wojdyła R, Mika P, Wańha W, et al. Aspiration Thrombectomy in Patients with Acute Myocardial Infarction-5-Year Analysis Based on a Large National Registry (ORPKI). J Clin Med. 2020;9(11):3610. doi: https://doi.org/10.3390/jcm9113610

Additional Files

Published

2025-04-29

How to Cite

1.
Khaniukov OO, Sapozhnychenko LV, Smolianova OV, Bashmakov ID. Predictors of the no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction due to stenotic coronary artery disease. Zaporozhye Medical Journal [Internet]. 2025Apr.29 [cited 2025May2];27(2):105-9. Available from: https://zmj.zsmu.edu.ua/article/view/320492