Research Article

Incidence and outcome of no flow after primary percutaneous coronary intervention in acute myocardial infarction

Goutam Datta*

Published: 31 August, 2020 | Volume 5 - Issue 2 | Pages: 153-156

Background: Primary percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) is the most effective treatment modality in ST-segment elevation myocardial infarction (STEMI). Incidence of no flow is 8.8% - 10% in primary PCI of STEMI patients. Our aim was to study actual incidence and outcome of no flow patients.

Methods: Five hundred and eighty primary PCI patients were enrolled and evaluated from 2016 January to 2017 December.

We used drug eluting stents in all cases. Majority of our patients (> 90%) presented to emergency six hours after onset of symptoms. There were many patients where there was no flow even after mechanical thrombus aspiration and pharmacological vasodilator therapy. We have studied primary outcome (mortality) of no flow in those patients.

Results: There were 44 cases of no flow in our series (7.75%). Involvement of Left anterior descending artery (LAD) was in eighteen patients. Right coronary artery (RCA) was culprit in twenty four cases. Only two cases were seen in LCX territory. One month mortality rate in no flow group was 50% and 6.25% in successful recanalization group. One year mortality was 12.5% in successful recanalization group and 66% in no flow group.

Conclusion: Refractory no flow during STEMI intervention is associated with increased incidence of major adverse cardiovascular events (MACE).

There is no established strategy to solve this phenomenon.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001102 Cite this Article Read Full Article PDF


Primary PCI; No flow; Mortality


  1. Prasad S, Meredith IT. Current approach to slow flow and no Reflow. Cardiac Interventions Today. 2008; 43-49.
  2. Triantafyllou K, Metaxopoulos P, Babalis D. Primary percutaneous coronary intervention of an unprotected left main using mini-crush drug-eluting stents facilitated by intracoronary reteplase. Catheter Cardiovasc Interv. 2011; 77: 515-521.
  3. Rezkalla SH, Dharmashankar KC, Abdalrahman IB, Kloner RA. No-reflow phenomenon following percutaneous coronary intervention for acute myocardial infarction: incidence, outcome, and effect of pharmacologic therapy. J Interv Cardiol. 2010; 23: 429–436. PubMed: https://pubmed.ncbi.nlm.nih.gov/20819117/
  4. Wang HJ, Lo PH, Lin JJ, Lee H, Hung S. Treatment of slow/no-reflow phenomenon with intracoronary nitroprusside injection in primary coronary intervention for acute myocardial infarction. Catheter Cardiovasc Interv. 2004; 63: 171–176. PubMed: https://pubmed.ncbi.nlm.nih.gov/15390241/
  5. Amano H, Ikeda T, Toda M, Okubo R, Yabe T, et al. Plaque composition and no-reflow phenomenon during percutaneous coronary intervention of low-echoic structures in grayscale intravascular ultrasound. Int Heart J. 2016; 57: 285–291. PubMed: https://pubmed.ncbi.nlm.nih.gov/27170472/
  6. Iwakura K, Ito H, Ikushima M, Kawano S, Okamura A, et al. Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction. J Am Coll Cardiol. 2003; 41: 1–7. PubMed: https://pubmed.ncbi.nlm.nih.gov/12570936/
  7. Li X, Yang Y, Hao Y, Yang Y, Zhao J, et al. Effects of pre-procedural statin therapy on myocardial no-reflow following percutaneous coronary intervention: A Meta-analysis. Chin Med J. 2013; 126:1755–1760. PubMed: https://pubmed.ncbi.nlm.nih.gov/23652063/
  8. Grygier M, Araszkiewicz A, Lesiak M, Grajek S. Role of adenosine as an adjunct therapy in the prevention and treatment of no-reflow phenomenon in acute myocardial infarction with ST segment elevation: review of the current data. Kardiologia Poloska. 2013; 71: 115–120.
  9. Higashi H, Inaba S, Nishimura K, Hamagami T, Fujita Y, et al. Usefulness of Adjunctive Pulse Infusion Thrombolysis After FailedAspiration for Massive Intracoronary Thrombus. Canadian J Cardiol. 2011; 27: 869- 869.
  10. Rezkalla SH, Stankowski RV, Hanna J, Kloner RA. Management of No-Reflow Phenomenon in the Catheterization Laboratory. JACC: Cardiovasc Interv. 2017; 10: 215-223. PubMed: https://pubmed.ncbi.nlm.nih.gov/28183461/


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