Association and Prognostic Implications of "No-Reflow Phenomenon" and Hypercoagulability in Patients With ST-Segment Elevation Myocardial Infarction
- PMID: 40910963
- DOI: 10.1016/j.jacasi.2025.07.015
Association and Prognostic Implications of "No-Reflow Phenomenon" and Hypercoagulability in Patients With ST-Segment Elevation Myocardial Infarction
Abstract
Background: Following percutaneous coronary intervention (PCI), the "no-reflow phenomenon" is associated with a worse outcome. However, it remains unclear how to prevent and treat this phenomenon during PCI.
Objectives: This study aimed to evaluate the association between thrombogenicity profiles and "no-reflow phenomenon" during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI).
Methods: From a real-world registry, we prospectively enrolled patients with STEMI who underwent primary PCI (n = 334). Thrombolysis In Myocardial Infarction flow grade was assessed at final angiography, and the "no-reflow phenomenon" was defined as Thrombolysis In Myocardial Infarction flow between 0 and 2. Thrombogenicity profiles were assessed with thromboelastography (TEG) and conventional hemostatic measurements.
Results: Thirty-seven patients (11.1%) showed no-reflow after primary PCI. High platelet-fibrin clot strength (P-FCS: ≥ 68 mm) measured by TEG was significantly associated with an increased risk of post-PCI "no-reflow phenomenon" (OR: 2.611; 95% CI: 1.220-5.584; P = 0.010). The risk stratification with "no-reflow phenomenon" and "high P-FCS phenotype" appeared to be additive to predict the risk of 3-year clinical event (log-rank P < 0.001 across the groups). Patients with both "no-reflow phenomenon" and high P-FCS had a higher risk of adverse clinical events compared with normal-reflow subjects with low P-FCS (adjusted HR: 6.654; 95% CI: 2.678-16.530; P < 0.001).
Conclusions: This study demonstrated a close relationship between heightened thrombogenicity (assessed by TEG P-FCS) with "no-reflow phenomenon," and their additive prognostic implications after primary PCI in STEMI patients. Effective control of clot strength may reduce the risk of "no-reflow phenomenon" and improve clinical outcomes in these patients. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529).
Keywords: acute myocardial infarction; cardiovascular event; clot strength; no-reflow phenomenon; percutaneous coronary intervention.
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures This research was supported by the Chung-Ang University Research Grants. The content is solely the responsibility of the authors and does not necessarily represent the official views of any funding agencies. The sponsors played no role in this study. There was no industry involvement in the design or conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication. Dr Gurbel has received grants and personal fees from Bayer HealthCare, Otitopic, Amgen, Janssen, and US WorldMeds; grants from Instrumentation Laboratory, Hikari Dx, Haemonetics, Medicure, and Idorsia Pharmaceuticals; and personal fees from UpToDate; and has patents “Detection of Restenosis Risk in Patients Issued” and “Assessment of Cardiac Health and Thrombotic Risk in a Patient.” Dr Jeong has received honoraria for lectures from Daiichi-Sankyo, Sanofi-Aventis, Hanmi Pharmaceuticals, and Daewoong Pharmaceuticals; and research grants or support from Samjin Pharmaceuticals, Hanmi Pharmaceuticals, Yuhan Pharmaceuticals, Biotronik Korea, and U and I Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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