Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar-Apr;20(2):31-40.
doi: 10.48305/arya.2024.42104.2921.

The assessment of no-reflow phenomenon incidence in early versus delayed percutaneous coronary intervention following a primary fibrinolysis

Afshin Amirpour  1 , Mohammad Amin Behjati  2 , Reihaneh Zavar  3 , Ehsan Shirvani  2 , Ehsan Zarepour  4 , Razieh Hassannejad  4 , Masoumeh Sadeghi  1 , Raheleh Janghorbanian Poodeh  3 , Ali Safaei  3 , Shahin Sanaei  5 , Nazanin Mahin Parvar  6
Affiliations

The assessment of no-reflow phenomenon incidence in early versus delayed percutaneous coronary intervention following a primary fibrinolysis

Afshin Amirpour et al. ARYA Atheroscler. 2024 Mar-Apr.

Abstract

Background: Percutaneous coronary intervention (PCI) is the gold standard approach to ST-Segment Elevation Myocardial Infarction (STEMI). Fibrinolysis followed by PCI has been recommended. The current study aims to investigate the no-reflow phenomenon incidence in patients undergoing post-thrombolytic therapy PCI.

Methods: This cross-sectional study was conducted on 250 patients with STEMI who primarily received fibrinolytic therapy followed by early (3-24 hours) (n=231) or delayed (> 24 hours) (n=19) PCI. They were also subcategorized into four intervals: <6 hours (n=98), 6-12 hours (n=93), 12-24 hours (n=38), and ≥24 hours (n=21). The demographic and medical data of the patients were retrieved. The Thrombolysis in Myocardial Infarction score (TIMI) was assessed at baseline and at the end of PCI. A TIMI score other than 3 was defined as no-reflow.

Results: The incidence of the no-reflow phenomenon was not associated with any of the underlying demographic and medical characteristics of the patients (P-value>0.05). Despite the significantly higher rate of improvement in TIMI grading among those undergoing early PCI (P-value=0.04), as well as within less than 6 hours after thrombolytic therapy (P-value=0.031), the rate of the no-reflow phenomenon did not differ between the groups, neither by sorting them as early versus delayed (P-value=0.518) nor by categorizing them into four intervals (P-value=0.367).

Conclusion: Based on the findings of the current study, early PCI after fibrinolysis led to significantly improved TIMI flow. However, the incidence of no-reflow did not differ between the groups with early versus delayed post-fibrinolysis PCI.

Keywords: Fibrinolysis; Myocardial Infarction; No-Reflow Phenomenon; Percutaneous Coronary Intervention; ST-Elevation Myocardial Infarction.

PubMed Disclaimer

Conflict of interest statement

The authors of the current study have no conflict of interest to disclose.

References

    1. Kilic S, Turkoglu C. Timing of Coronary Angiography After Successful Fibrinolytic Therapy in ST-Segment Elevated Myocardial Infarction. Cardiol Res. 2019 ;10(1):34–9. - PMC - PubMed
    1. Forouzannia SK, Abdollahi MH, Mirhosseini SJ, Hadadzadeh M, Zarepur R, Zarepur E, et al. Adenosine Preconditioning versus Ischemic Preconditioning in Patients undergoing Off-Pump Coronary Artery Bypass (OPCAB) J Tehran Heart Cent. 2013 ;8(3):127–31. - PMC - PubMed
    1. Berwanger O, Abdelhamid M, Alexander T, Alzubaidi A, Averkov O, Aylward P, et al. Use of ticagrelor alongside fibrinolytic therapy in patients with ST-segment elevation myocardial infarction: Practical perspectives based on data from the TREAT study. Clin Cardiol. 2018 ;41(10):1322–7. - PMC - PubMed
    1. T O’Gara P, Kushner FG, Ascheim DD, Casey Jr DE, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):485–510. - PubMed
    1. Tariq MN, Samore NA, Rashid MH, Nadeem A, Saif M, Jokhio AR, et al. In-Hospital Outcome of Early Versus Late Coronary Intervention in Patients Undergoing Thrombolysis after Acute Myocardial Infarction. Pak Armed Forces Med J. 2022;72(SUPPL-3):S472–6.

LinkOut - more resources