Prevalence and Predictors of No-Reflow Phenomenon in Patients with Acute Coronary Syndrome in Slemani Cardiac Hospital

Authors

  • Binar Yadgar Raouf Heshmet MBChB, Slemani Cardiac Hospital, Slemani-Iraq.
  • Dana Hama Baqi Mohammed Saeed MBChB, DFMS cardiology. DIU interventional cardiology, DIU echocardiography, University of Slemani, Slemani, Kurdistan Region, Iraq
  • Ammar Al-hamdi MBChB, MRCP (UK), FRCP (Ed.), Professor of Medicine/Cardiology, Senior Consultant Cardiologist/Electrophysiologist

DOI:

https://doi.org/10.56056/413

Keywords:

Acute Coronary Syndrome , Dyslipidemia, Hypertension, No-Reflow Phenomenon, Percutaneous Coronary Intervention

Abstract

Background and objectives: Understanding factors linked to the no-reflow phenomenon after percutaneous coronary intervention in acute coronary syndromes is important for optimizing reperfusion strategies. The aim of this study is to determine the prevalence and predictors of no-reflow phenomenon in Slemani Cardiac Hospital.

Methods: This investigation was a prospective study that was carried out in Slemani Cardiac Hospital; between July 2023 until December 2023, of 150 acute coronary syndrome patients undergoing percutaneous coronary intervention collected data on demographics, clinical characteristics, angiographic findings, and procedural details. Patients were categorized into reflow and no-reflow groups based on final Thrombolysis in Myocardial Infarction flow. Associations between no-reflow and various parameters were analyzed.

Results: There was 70% male, with 21.3% hypertension, 4% diabetes, 3.3% dyslipidemia. Common presentations were non-ST elevation myocardial infarction (41.3%), inferior ST elevation myocardial infarction (28%). No significant lesions were seen in 32%. Reflow success rate was 94%, with 6% no-reflow. No-reflow associated with risk factors like dyslipidemia, hypertension, diabetes, and smoking, but not angiographic/procedural variables.

Conclusion: Cardiovascular risk factors emerged as key determinants of no-reflow, underscoring the importance of risk modification. The excellent reflow rates and lack of angiographic associations contrast some prior data, warranting further standardized research on no-reflow prediction and mechanisms to guide targeted interventions in acute coronary syndrome.

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References

1. Annibali G, Scrocca I, Aranzulla TC, Meliga E, Maiellaro F, Musumeci G. "No-Reflow" Phenomenon: A Contemporary Review. J. Clin. Med. 2022;11(8). DOI: 10.3390/jcm11082233/

2. Refaat H, Tantawy A, Gamal AS, Radwan H. Novel predictors and adverse long-term outcomes of No-reflow phenomenon in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. IHJ. 2021;73(1):35-43. DOI: 10.1016/j.ihj.2020.12.008/

3. Henriques JP, Zijlstra F, van 't Hof AW, de Boer MJ, Dambrink JH, Gosselink M, et al. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation. 2003;107(16):2115-9. DOI: 10.1161/01.CIR.0000065221. 06430.ED.

4. Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H, et al. Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. Journal of the American College of Cardiology. 2000;36(4):1202-9. DOI: 10.1016/s0735-1097(00)00865-2/

5. 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. 2020;99(26). DOI: 10.1097/MD.0000000000020152/

6. Fajar JK, Heriansyah T, Rohman MS. The predictors of no reflow phenomenon after percutaneous coronary intervention in patients with ST elevation myocardial infarction: A meta-analysis. IHJ. 2018;70: S406-S18. DOI: 10.1016/j.ihj.2018.01.032/

7. Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. J Am Coll Cardiol. 2009;54(4):281-92. DOI: 10.1016/j.jacc.2009.03.054/

8. Shakiba M, Salari A, Mirbolouk F, Sotudeh N, Nikfarjam S. Clinical, Laboratory, and Procedural Predictors of No-Reflow in Patients Undergoing Primary Percutaneous Coronary Intervention. J Tehran Heart Cent. 2020;15(2):50-6. DOI: 10.18502/jthc. v15i2.4183/

9. Khalfallah M, Allaithy A, Maria DA. Impact of the Total Ischemia Time on No-Reflow Phenomenon in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Anatol J Cardiol. 2022;26(5):382-7. DOI: 10.5152/AnatolJCardiol.2021.846/

10. Hosseini SH, Talasaz AH, Alidoosti M, Tajdini M, Van Tassell BW, Etesamifard N, et al. Preprocedural Colchicine in Patients with Acute ST-elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Randomized Controlled Trial (Pod CAST-PCI). J Cardiovasc Pharmacol. 2022;80(4):592-9. DOI: 10.1097/FJC.0000000000001317/

11. Mohammad AM, Rashad HH, Habeeb QS, Rashad BH, Saeed SY. Demographic, clinical and angiographic profile of coronary artery disease in kurdistan region of Iraq. Am J Cardiovasc Dis. 2021;11(1):39-45. PMID: 33815918.

12. Lin MJ, Chang YJ, Chen CY, Huang CC, Chuang TY, Wu HP. Influence of hypercholesterolemia and diabetes on long-term outcome in patients with stable coronary artery disease receiving percutaneous coronary intervention. Medicine (Baltimore). 2019;98(34): e16927. DOI: 10.1097/MD.0000000000016927/

13. Sobhy M, El Etriby A, El Nashar A, Wajih S, Horack M, Brudi P, et al. Prevalence of lipid abnormalities and cholesterol target value attainment in Egyptian patients presenting with an acute coronary syndrome. EHJ. 2018;70(3):129-34. DOI: 10.1016/j.ehj.2018.05.001/

14. Devlin G, Gore JM, Elliott J, Wijesinghe N, Eagle KA, Avezum A, et al. Management and 6-month outcomes in elderly and very elderly patients with high-risk non-ST-elevation acute coronary syndromes: The Global Registry of Acute Coronary Events. Eur Heart J. 2008 May 1;29(10):1275-82. DOI: 10.1093/eurheartj/ehn124/

15. Jernberg T, Johanson P, Held C, Svennblad B, Lindbäck J, Wallentin L. Association between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA 2011 Apr 27;305(16):1677-84. DOI: 10.1001/jama.2011.522/

16. Mahjoob MP, Sadeghi S, Khanaman HF, Naderian M, Khaheshi I. Comparison of coronary risk factors and angiographic findings in younger and older patients with significant coronary artery disease. Rom J Intern Med. 2018 Jun 1;56(2):90-5. DOI: 10.1515/rjim-2017-0048/

17. Stukel TA, Lucas FL, Wennberg DE. Long-term outcomes of regional variations in intensity of invasive vs medical management of Medicare patients with acute myocardial infarction. JAMA. 2005 Mar 16;293(11):1329-37. DOI: 10.1001/jama.293.11.1329/

18. Stone GW, Maehara A, Lansky AJ, De Bruyne B, Cristea E, Mintz GS, et al.A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011 Jan 20;364(3):226-35. DOI: 10.1056/NEJMoa1002358/

19. Stone GW, Moses JW, Ellis SG, Schofer J, Dawkins KD, Morice MC, et al. Safety and efficacy of sirolimus-and paclitaxel-eluting coronary stents. N Engl J Med. 2007 Mar 8;356(10):998-1008. DOI: 10.1056/NEJMoa067193/

20. Loubeyre C, Morice MC, Lefèvre T, Piéchaud JF, Louvard Y, Dumas P. A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction. J Am Coll Cardiol. 2002 Jan 2;39(1):15-21. DOI: 10.1016/s0735-1097(01)01701-6/

21. Mamas MA, Ratib K, Routledge H, Fath-Ordoubadi F, Neyses L, Louvard Y, et al. Influence of access site selection on PCI-related adverse events in patients with STEMI: meta-analysis of randomised controlled trials. Heart. 2012 Feb 15;98(4):303-11. DOI: 10.1136/heartjnl-2011-300558/

22. Topol E, Califf R, Weisman H, Ellis S, Tcheng J, Worley S, et al. Randomised trial of coronary intervention with antibody against platelet IIb/IIIa iritegrin for reduction of clinical restenosis: Results at six months. The Lancet. 1994 Apr 9;343(8902):881-6. DOI: 10.1016/s0140-6736(94)90007-8/

23. Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001 Jun 21;344(25):1879-87. DOI: 10.1056/NEJM200106213442501/

24. Nordmann AJ, Hengstler P, Harr T, Young J, Bucher HC. Clinical outcomes of primary stenting versus balloon angioplasty in patients with myocardial infarction: a meta-analysis of randomized controlled trials. Am J Med. 2004 Feb 15;116(4):253-62. DOI: 10.1016/j.amjmed.2003.08.035/

25. Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention. Circulation. 2008 Jun 17;117(24):3152-6. DOI: 10.1161/CIRCULATIONAHA.107.742312/

26. Rezkalla SH, Kloner RA. No-reflow phenomenon. Circulation. 2002 Feb 5;105(5):656-62. DOI: 10.1161/hc0502.102867/

27. Mark DB, Shaw L, Harrell Jr FE, Hlatky MA, Lee KL, Bengtson JR, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med1991 Sep 19;325(12):849-53. DOI: 10.1056/NEJM199109193251204/

28. Iwakura K, Ito H, Ikushima M, Kawano S, Okamura A, Asano K, et al. Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction. J Am Coll Cardiol. 2003 Jan 1;41(1):1-7. DOI: 10.1016/s0735-1097(02)02626-8/

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Published

2025-12-01

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How to Cite

Prevalence and Predictors of No-Reflow Phenomenon in Patients with Acute Coronary Syndrome in Slemani Cardiac Hospital. (2025). AMJ (Advanced Medical Journal) , 10(4), 180-188. https://doi.org/10.56056/413