No‐Reflow Phenomenon Following Percutaneous Coronary Intervention for Acute Myocardial Infarction: Incidence, Outcome, and Effect of Pharmacologic Therapy

Abstract

NR is common in STEMI. Treatment with nicardipine, nitroprusside, and verapamil are equally effective in improving flow. If not treated, prognosis is poor.

Intramyocardial haemorrhage after acute myocardial infarction

“…7 In response to vessel manipulation during PCI, noreflow can develop in a dramatic fashion and presents with stagnation of contrast medium in epicardial arteries, persistent myocardial blush, and frequently, electrocardiographic and haemodynamic changes. 2,73 This sequence reinforces a causative link between the culprit lesion and no-reflow. In pathological studies of patients who died after acute coronary syndromes, microembolization of thrombus and atheromatous gruel were frequent findings, which suggests that these features could be causal factors in no-reflow.…”

“…[1][2][3] Although timely primary PCI restores epicardial patency effectively in most cases, 1 cardiac function does not fully recover in 50% of reperfused patients owing to impairment of microvascular flow, known as the 'no-reflow' phenomenon. This event is poorly understood and is a matter of much debate, but can largely nullify the benefits of early intervention.…”

“…This event is poorly understood and is a matter of much debate, but can largely nullify the benefits of early intervention. 2 Although no-reflow was first reported in animal models, interest has resulted mainly from it being recognized as a major clinical problem related to PCI. 3 Substantial evidence supports the concept that no-reflow arises owing to blockage of the coronary microcirculation by downstream embolization of microthrombi or atheroma dislodged from the culprit lesion, either spontaneously or as a result of manipulation during PCI.…”

Predictive value of admission red cell distribution width-platelet ratio for no-reflow phenomenon in acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

“…Patients were classified into two groups based on postintervention TIMI flow grade [11]. No reflow was defined as TIMI flow grades 0-2 (no-reflow group) and reflow was defined as TIMI 3 flow grade [12][13][14][15].…”

Impervious Coronary No-Reflow: A Case Study

“…Coronary slow-reflow or no-reflow is diagnosed when TIMI flow grades of 1 or 2, high TIMI frame count, or abnormal myocardial blush is observed immediately post PCI [2]. The phenomenon occurs in approximately 30% of patients receiving PCI for acute myocardial infarction [4,5]. The proposed etiology of coronary no-reflow phenomenon is multifactorial and includes distal embolization of thrombus fragments during PCI, inflammation of the endothelium leading to microvascular dysfunction, reperfusion injury, and vasospasm [6][7][8].…”