No-reflow leads to negative outcomes in acute heart attack patients

January 7, 2013 – Study found that no-reflow is associated with adverse clinical outcomes

No-reflow is a known complication for patients undergoing percutaneous coronary intervention (PCI) after suffering acute myocardial infarction (AMI), or a heart attack. No-reflow means that coronary blood flow remains impaired even after the epicardial coronary artery is no longer blocked. A recent DCRI-led study has concluded that although no-reflow is uncommon during PCI for AMI, it is associated with adverse clinical outcomes.

Robert Harrison, MD, was lead author on this study, which included contributions by the DCRI’s Fang-shu Ou, MS; Matthew Roe, MD, MHS; and Tracy Wang, MD, MHS. It was published in the January issue of the American Journal of Cardiology.

This was the largest study of no-reflow in patients receiving PCI for AMI. Patient information was reviewed from the National Cardiovascular Data Registry’s CathPCI Registry and included a cohort of more than 290,000 patients from more than 880 hospitals. Among these patients, 2.3 percent developed no-reflow. The no-reflow phenomenon was more common in patients with ST-segment elevation myocardial infarction (STEMI) than in non-STEMI patients.

The incidence of no-reflow was lower in this study, compared with previous studies. The researchers explain that this could be a result of a recently implemented standardized definition of no-reflow, which is much less liberal than definitions used in previous studies. Another reason for the lower incidence rate is improvements in adjunctive pharmacology and catheter-based techniques in the contemporary PCI population.

The study found that patients with AMI who developed no-reflow had a greater rate of death, both in the catheterization laboratory and during overall hospitalization. As with previous studies, the findings indicated that the presence of intraprocedural complications, like no-reflow, increases the risk of major adverse clinical events in patients with AMI undergoing PCI. The researchers recommend developing upfront strategies to reduce the incidence of no-reflow for high-risk patients.