No-reflow phenomenon natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Jennifer Giuseffi, M.D.; David M. Leder, M.D.; Ayokunle Olubaniyi, M.B,B.S [2]

Overview

Natural History, Complications and Prognosis

In the cathetarization laboratory, no-reflow may be clinically silent or appear suddenly associated with severe chest pain, ischemic (EKG) changes, conduction abnormalities, and/or hemodynamic deterioration. This needs to be distinguished from slow-flow which can be caused by coronary dissection, macrothrombus formation, coronary vasospasm, or distal macroembolization. The presence of no-reflow is clinically important as its presence has been associated with a five to ten fold increase in mortality,[1] as well as a high incidence of myocardial infarction (MI), left ventricular dysfunction, ventricular arrhythmias, early congestive heart failure and cardiogenic shock. Predictors of outcome include:

  • Duration of coronary occlusion
  • Extent of myocardium supplied by the occluded artery
  • Patency of infarct-related artery
  • Quality of collateral circulation
  • Presence of pre-infarction angina which produces a preconditioning-like effect and might correlate with preservation of collateral circulation.

Hyperglycemia in acute myocardial infarction is associated with an increased risk of in-hospital mortality, as well as no-reflow phenomenon.


References

  1. Resnic, FS.; Wainstein, M.; Lee, MK.; Behrendt, D.; Wainstein, RV.; Ohno-Machado, L.; Kirshenbaum, JM.; Rogers, CD.; Popma, JJ. (2003). "No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention". Am Heart J. 145 (1): 42–6. doi:10.1067/mhj.2003.36. PMID 12514653. Unknown parameter |month= ignored (help)


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