Prediction of no-reflow phenomenon in endovascular treatment of patients with acute ST segment elevation myocardial infarction

Bessonov E.Yu.; Shishkevich A.N.; Mikhailov S.S.; Kravchuk V.N.

doi:https://doi.org/10.17116/Cardiobulletin20241904152

Bessonov E.Yu.

Alexandrovskaya Hospital

ORCID: 0000-0003-2960-6543

Shishkevich A.N.

Kirov Military Medical Academy;
Mechnikov Northwestern State Medical University

ORCID: 0000-0003-4605-6678

Mikhailov S.S.

Kirov Military Medical Academy;
Mechnikov Northwestern State Medical University

ORCID: 0000-0001-6093-2203

Kravchuk V.N.

Kirov Military Medical Academy;
Mechnikov Northwestern State Medical University

ORCID: 0000-0002-6337-104X

Prediction of no-reflow phenomenon in endovascular treatment of patients with acute ST segment elevation myocardial infarction

Authors:

Bessonov E.Yu., Shishkevich A.N., Mikhailov S.S., Kravchuk V.N.

More about the authors

Journal: Russian Cardiology Bulletin. 2024;19(4): 52‑58

DOI: 10.17116/Cardiobulletin20241904152

Read: 736 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Bessonov EYu, Shishkevich AN, Mikhailov SS, Kravchuk VN. Prediction of no-reflow phenomenon in endovascular treatment of patients with acute ST segment elevation myocardial infarction. Russian Cardiology Bulletin. 2024;19(4):52‑58. (In Russ.)
https://doi.org/10.17116/Cardiobulletin20241904152

Подписка 2026 Кардиологический вестник (Russian Cardiology Bulletin)

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

To identify predictors and regression model for no-reflow phenomenon in patients with STEMI.

MATERIAL AND METHODS

A retrospective study included 143 STEMI patients who underwent infarct-related artery stenting. We estimated predictors of no-reflow phenomenon and developed appropriate prognostic model. The control group of 50 people tested performance of the model.

RESULTS

Preoperative TIMI grade of antegrade blood flow < 0—1, TIMI thrombus grade 4—5, structure of coronary arteries, leukocytosis, neutrophilia, serum glucose, period between painful attack and percutaneous coronary intervention, as well as previous diabetes mellitus are factors influencing the likelihood of no-reflow phenomenon. The mathematical model has high predictive value (AUC 0.86, p<0.01).

CONCLUSION

The main pattern of no-reflow phenomenon in STEMI patients undergoing PCI is a combination of distal embolism with severity of inflammatory process. This corresponds to pathophysiological hypothesis of this complication after myocardial revascularization.

Keywords:

no-reflow phenomenon

ST-segment elevation myocardial infarction

myocardial revascularization

coronary artery stenting

Authors:

Bessonov E.Yu.

Alexandrovskaya Hospital

ORCID: 0000-0003-2960-6543

Shishkevich A.N.

Kirov Military Medical Academy;
Mechnikov Northwestern State Medical University

ORCID: 0000-0003-4605-6678

Mikhailov S.S.

Kirov Military Medical Academy;
Mechnikov Northwestern State Medical University

ORCID: 0000-0001-6093-2203

Kravchuk V.N.

Kirov Military Medical Academy;
Mechnikov Northwestern State Medical University

ORCID: 0000-0002-6337-104X

Received:

20.02.2024

Accepted:

17.06.2024

Close metadata

References:

Khubulava GG, Kozlov KL, Shishkevich AN, Mikhailov SS, Bessonov EYu, Tokarev PA, Pachkov DA, Bobrovskaya EE. Predictors of myocardial reperfusion syndrome: a modern view of the issue and current problems. Part 2: the phenomenon of unrestored coronary blood flow, or the no-reflow phenomenon (literature review). Regionarnoe krovoobrashchenie i mikrocirkulyaciya. 2021;3(79):4-10. (In Russ.) https://doi.org/10.24884/1682-6655-2021-20-3-4-10
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2017;39(2):119-177. https://doi.org/10.1093/eurheartj/ehx393
Jolly SS, Cairns JA, Yusuf S, Rokoss MJ, Gao P, Meeks B, Kedev S, Stankovic G, Moreno R, Gershlick A, Chowdhary S, Lavi S, Niemela K, Bernat I, Cantor WJ, Cheema AN, Steg PG, Welsh RC, Sheth T, Bertrand OF, Avezum A, Bhindi R, Natarajan MK, Horak D, Leung RC, Kassam S, Rao SV, El-Omar M, Mehta SR, Velianou JL, Pancholy S, Džavík V; TOTAL Investigators. Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial. Lancet. 2016; 9(387):127-135. https://doi.org/10.1016/S0140-6736(15)00448-1
Niccoli G, Montone RA, Ibanez B, Thiele H, Crea F, Heusch G, Bulluck H, Hausenloy DJ, Berry C, Stiermaier T, Camici PG, Eitel I. Optimized Treatment of ST-Elevation Myocardial Infarction. Circulation Research. 2019;5;125(2):245-258. https://doi.org/10.1161/CIRCRESAHA.119.315344
Frolov AA, Pochinka IG, Shahov BE, Sharabrin EG, Kuzmichev KV. The phenomenon of coronary microvascular obstruction (no-reflow) during percutaneous coronary interventions in patients with myocardial infarction. Patologiya krovoobrascheniya I kardiohirurgiya. 2020;24(1):18-27. (In Russ.) https://doi.org/10.21688/1681-3472-2020-1-18-27
Khan AU, Akbar F, Ullah S, Zeb H. Frequency of No-Reflow Phenomenon in Patients Treated with Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Journal of Health and Rehabilitation Research. 2024;4(1):1041-1049. https://doi.org/10.61919/jhrr.v4i1.573
Ozturk E, Esenboga K, Kurtul A, Kilickap M, Karaagaoglu E, Karakaya J. Measurement of Uncertainty in Prediction of No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention Using Systemic Immune Inflammation Index: The Gray Zone Approach. Diagnostics. 2023;13(4):709. https://doi.org/10.3390/diagnostics13040709
Kpelafia M, Chamtouri I, Moukaila A, Khaldoun B, Jomaa W, Maatouk F. Predictive Factors of No Reflow during Primary Angioplasty. World Journal of Cardiovascular Diseases. 2023;13(1):32-45. https://doi.org/10.4236/wjcd.2023.131004
Wang JW, Zhou ZQ, Chen YD, Wang CH, Zhu XL. A risk score for no reflow in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Clinical Cardiology. 2015;38(4):208-15. https://doi.org/10.1002/clc.22376
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 (Baltimore). 2020;99(26):e20152. https://doi.org/10.1097/MD.0000000000020152
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. Indian Heart Journal. 2018;70(3):406-418. https://doi.org/10.1016/j.ihj.2018.01.032
Booth G, Stalker TJ, Lefer AM, Scalia R. Elevated ambient glucose induces acute inflammatory events in the microvasculature: effects of insulin. American Journal of Physiology. 2001;280(6):848-856. https://doi.org/10.1152/ajpendo.2001.280.6.E848
Bitsadze VO, Slukhanchuk EV, Khizroeva DKh, Tretyakova MV, Shkoda AS, Radetskaya LS, Makatsariya AD, Elalami I, Gris Zh-K, Grandone E. Extracellular traps of neutrophils (networks) in the pathogenesis of thrombosis and thromboinflammatory complications. Vestnik Rossijskoj akademii medicinskih nauk. 2021;76(1):75-85. (In Russ.)] https://doi.org/10.15690/vramn1395