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Review
. 2022 Apr 8;12(4):932.
doi: 10.3390/diagnostics12040932.

A Narrative Review of the Classical and Modern Diagnostic Methods of the No-Reflow Phenomenon

Larisa Renata Pantea-Roșan  1 , Simona Gabriela Bungau  2   3 , Andrei-Flavius Radu  2   4 , Vlad Alin Pantea  5 , Mădălina Ioana Moisi  4 , Cosmin Mihai Vesa  4 , Tapan Behl  6 , Aurelia Cristina Nechifor  7 , Elena Emilia Babes  1 , Manuela Stoicescu  1 , Daniela Gitea  3 , Diana Carina Iovanovici  2 , Cristiana Bustea  4
Affiliations
Review

A Narrative Review of the Classical and Modern Diagnostic Methods of the No-Reflow Phenomenon

Larisa Renata Pantea-Roșan et al. Diagnostics (Basel). .

Abstract

The incidence of the no-reflow (NR) phenomenon varies depending on the diagnostic criteria used. If just the angiographic criteria are considered (i.e., a degree of thrombolysis in myocardial infarction ≤2), it will be found that the incidence of NR is quite low; on the other hand, when the myocardial NR is taken into account (i.e., a decrease in the quality of myocardial reperfusion expressed by the degree of myocardial blush), the real incidence is higher. Thus, the early establishment of a diagnosis of NR and the administration of specific treatment can lead to its reversibility. Otherwise, regardless of the follow-up period, patients with NR have a poor prognosis. In the present work, we offer a comprehensive perspective on diagnostic tools for NR detection, for improving the global management of patients with arterial microvasculature damage, which is a topic of major interest in the cardiology field, due to its complexity and its link with severe clinical outcomes.

Keywords: acute myocardial infarction; diagnostic methods; echocardiogram; electrocardiogram; myocardial blush grade; no-reflow phenomenon; thrombolysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram describing literature selection.
Figure 2
Figure 2
The main pathophysiological mechanisms involved in no-reflow (NR) apparition in STEMI after PCI, mainly occurring because of pre-existing lesions or other favoring factors, or worsened by the procedure itself. PCI, percutaneous coronary intervention; STEMI, segment elevation myocardial infarction.
Figure 3
Figure 3
Predictors of the no-reflow phenomenon. ADMA, asymmetric dimethylarginine; CV, Cardiovascular; LAD, left anterior descending coronary artery; MI, myocardial infarction; NO, nitric oxide; ROS, reactive oxygen species.
Figure 4
Figure 4
Characteristic aspects of no-reflow phenomenon diagnosis based on ECG: (a) normal ECG without ST segment changes (isoelectric); (b) ECG in a subject diagnosed with STEMI at admission showing anterior ST segment elevation of 6 mm (precordial leads V1-V6); (c) the same patient from (b)—ECG at 2 h after PPCI of the culprit lesion showing persistent ST segment elevation of 5–6 mm (precordial leads V1-V6) without expected ST segment resolution of more than 70%.
Figure 5
Figure 5
No-reflow phenomenon appear at the circumflex artery (indicated by the red arrow).
See this image and copyright information in PMC

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