Prognostic value of no-reflow phenomenon in myocardial infarction: the role of the severity of ischemic damage

Aim. To create a scale for assessing the myocardial ischemia severity and to study the effect of concomitant ischemia on the prognosis of myocardial infarction (MI) complicated by no-reflow phenomenon during percutaneous coronary intervention (PCI).

Material and methods. A single-center cohort study was conducted. There were following inclusion criteria: MI, PCI, total ischemic time <48 h and no-reflow (TIMI flow grade <3 or Myocardial blush grade <2 or ST segment resolution <70%). The proposed scale included infarction-related lesion in the left main coronary artery or proximal left anterior descending artery — 2 points; total ischemic time >12 h — 1 point; TIMI flow grade 0-1 before PCI — 1 point; Rentrop collateral circulation grade 0-1 — 1 point. Severe ischemia — more than 3 points. Propensity score matching was used to correct differences between the groups. Median follow-up was 979 [743; 1318] days.

Results. A total of 18079 patients with acute coronary syndrome were analyzed, while 219 were included. After comparison, 105 patients remained as follows: group 1 — 75 patients without assessed severe ischemia; group 2 — 30 patients with assessed severe ischemia. During the hospital stage, 6 (8,0%) and 9 (30,0%) patients died, respectively, p<0,001. The left ventricular ejection fraction was 47 [42; 50]% and 41 [39; 45]%, respectively, p<0,001. Severe ischemia was associated with a 4,15-fold increase in the long-term death risk (95% confidence interval 1,87-9,20; p<0,001).

Conclusion. Concomitant severe ischemic damage in MI complicated by no-reflow during PCI is associated with worse left ventricular function and a higher death risk at the hospital stage and in the long-term follow-up period.

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