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
- ↑ 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
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