Clinical factors associated with the no/slow-reflow phenomenon in patients with acute coronary syndrome

Abstract

Aim. To determine the incidence of the no-reflow phenomenon in patients with acute coronary syndrome (ACS) undergoing primary percutaneous coronary intervention (PCI), and to study factors associated with its occurrence in the daily work of the City Clinical Hospital.Material and methods. Of the 2090 patients with ACS admitted to N. I. Pirogov City Clinical Hospital No.1 in the period from 01.01.2017 to 01.11.2022 there were 2 groups of patients with PCI: group 1 (n=59) included patients with initial antegrade coronary blood flow TIMI 0 and final blood flow TIMI 0-2 (with the no/ slow-reflow phenomenon); Group 2 (n=149) included patients with initial coronary blood flow TIMI 0 and final antegrade coronary blood flow TIMI 3 (without the no/slow-reflow phenomenon).Results. The no-/slow-reflow phenomenon was observed in 2.8% of cases. Patients with no-/slow-reflow phenomenon more frequently had diabetes mellitus (42.4% vs. 22.8%, p=0.003), a history of stroke (12.1% vs. 3.4%, p=0.016), higher Killip class and "pain-to-balloon" time 7 [3; 16] vs. 4 [2.3; 8.25] hours, p=0.004. Binary logistic regression identified "pain-to-balloon" time as the most significant predictor of no-/slow-reflow phenomenon development [Odds Ratio (OR)=1.03; 95% CI: 0.95-0.996; p=0.02] and the proximal level of occlusion in infarct-related coronary artery. The incidence of in-hospital mortality was 6.1 times higher in the no-/slow-reflow group compared to the normal blood flow group [OR=6.102±0.433; 95% CI: 2.614-14.247; p<0.05].Conclusion. The development of the no-/slow-reflow phenomenon was observed in 2.8% of patients in clinical practice N. I. Pirogov City Clinical Hospital No.1. Its development was associated with an increase in the incidence of unfavorable outcome of the disease in the hospital. The total time of myocardial ischemia, the presence of diabetes mellitus, a history of stroke, and a higher Killip class of acute heart failure at admission were more often associated with the development of the no-/slow-reflow phenomenon. The proximal level of damage to the infarct-related artery and "pain-to-balloon" time were independent predictors of the no-/slowreflow phenomenon.