JHSM
Journal of Health Sciences and Medicine

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

ISSN: Active
eISSN: 2636-8579
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Submit Manuscript

Index
Original Article
Predictors of no-reflow after coronary stenting in patients with high thrombus burden
Abstract
Aims: In this study, we aimed to reveal the predictors of no-reflow after coronary stenting in patients with high thrombus burden.
Methods: Patients with acute myocardial infarction who underwent stenting of a coronary lesion with high thrombus burden in the same session between February 2020 and July 2022 in our center were included in this retrospective study. High thrombus burden was accepted as Thrombolysis in Myocardial Infarction (TIMI) grade 4 or 5 thrombus. No-reflow was accepted as TIMI grade ?2 flow at the end of the procedure. Multivariate logistic regression analysis was executed to ascertain the predictors of no-reflow.
Results: Of the 485 patients included in the study, 407 (83.9%) did not develop no-reflow. Of the 78 (16.1%) patients who developed no-reflow at the end of the procedure, 61 had TIMI 2, 10 had TIMI 1, and 7 had TIMI 0 flow. Age [odds ratio (OR) 1.051; 95% confidence interval (CI) 1.021-1.082; p=.001], accumulated thrombus proximal to the occlusion (OR 3.318; 95% CI 1.176-9.365; p=.023), reference vessel diameter (RVD) greater than 4 mm (OR 2.569; 95% CI 1.005-6.565; p=.049), and TIMI flow grade after wiring or small balloon dilation (OR 0.108; 95% CI 0.065-0.181; p<.001) were the independent predictors of no-reflow.
Conclusion: Older age, accumulated thrombus proximal to the occlusion, RVD greater than 4 mm, and the absence of TIMI grade 3 flow after wiring or small balloon dilation may be associated with an increased risk of no-reflow after coronary stenting in patients with high thrombus burden.

Keywords : No-reflow, coronary stenting, high thrombus burden

Download Article


1. Eeckhout E, Kern MJ. The coronary no-reflow phenomenon: a review of mechanisms and therapies.Eur Heart J. 2001;22(9):729-739.
2. Brosh D, Assali AR, Mager A, et al. Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. Am J Cardiol. 2007;99(4):442-445. doi:10.1016/j.amjcard.2006.08.054
3. Gibson CM, Cannon CP, Murphy SA, et al. Relationship of the TIMI myocardial perfusion grades, flow grades, frame count, and percutaneous coronary intervention to long-term outcomes after thrombolytic administration in acute myocardial infarction. Circulation. 2002; 105(16):1909-1913. doi:10.1161/01.cir.0000014683.52177.b5
4. Bolognese L, Carrabba N, Parodi G, et al. Impact of microvascular dysfunction on left ventricular remodeling and long-term clinical outcome after primary coronary angioplasty for acute myocardial infarction. Circulation. 2004;109(9):1121-1126. doi:10.1161/01.CIR.0000 118496.44135.A7
5. Wu KC, Zerhouni EA, Judd RM, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation. 1998;97(8):765-772. doi: 10.1161/01.cir.97.8.765
6. Gibson CM, de Lemos JA, Murphy SA, et al. Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation. 2001;103(21): 2550-2554. doi:10.1161/01.cir.103.21.2550
7. Stevens PE, Levin A; kidney disease: improving global outcomes chronic kidney disease guideline development work group members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825-830. doi:10.7326/0003-4819-158-11-201306040-00007
8. Yip HK, Chen MC, Chang HW, et al. Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon. Chest. 2002;122(4):1322-1332. doi:10.1378/chest.122.4.1322
9. Fajar JK, Heriansyah T, Rohman MS. The predictors of no reflow phenomenon after percutaneous coronary intervention in patients with ST elevation myocardial infarction: a meta-analysis. Indian Heart J. 2018;70(Suppl 3):S406-S418. doi:10.1016/j.ihj.2018.01.032
10. Refaat H, Tantawy A, Gamal AS, Radwan H. Novel predictors and adverse long-term outcomes of No-reflow phenomenon in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Indian Heart J. 2021;73(1):35-43. doi:10.1016/j.ihj.2020.12.008
11. Zhou H, He XY, Zhuang SW, et al. Clinical and procedural predictors of no-reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention. World J Emerg Med. 2014;5(2):96-102. doi:10.5847/wjem.j.issn.1920-8642.2014.02.003
12. Mazhar J, Mashicharan M, Farshid A. Predictors and outcome of no-reflow post primary percutaneous coronary intervention for ST elevation myocardial infarction. Int J Cardiol Heart Vasc. 2015;10:8-12. doi:10.1016/j.ijcha.2015.11.002
13. Kirma C, Izgi A, Dundar C, et al. Clinical and procedural predictors of no-reflow phenomenon after primary percutaneous coronary interventions: experience at a single center. Circ J. 2008;72(5):716-721. doi:10.1253/circj.72.716
14. Cura FA, L&rsquo;Allier PL, Kapadia SR, et al. Predictors and prognosis of suboptimal coronary blood flow after primary coronary angioplasty in patients with acute myocardial infarction. Am J Cardiol. 2001;88(2):124-128. doi:10.1016/s0002-9149(01)01605-8
15. Sabin P, Koshy AG, Gupta PN, et al. Predictors of no- reflow during primary angioplasty for acute myocardial infarction, from medical college hospital, Trivandrum. Indian Heart J. 2017;69(Suppl 1):S34-S45. doi:10.1016/j.ihj.2016.12.012
16. Ruiz-Garc&iacute;a J, Lerman A, Weisz G, et al. Age- and gender-related changes in plaque composition in patients with acute coronary syndrome: the PROSPECT study. EuroIntervention. 2012;8(8):929-938. doi:10.4244/EIJV8I8A142
17. Celermajer DS, Sorensen KE, Spiegelhalter DJ, Georgakopoulos D, Robinson J, Deanfield JE. Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol. 1994;24(2):471-476. doi:10.1016/0735-1097 (94)90305-0
18. Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. J Am Coll Cardiol. 2009;54(4):281-292. doi:10.1016/j.jacc.2009. 03.054
19. Brilakis E. Chapter 20: Acute coronary syndromes&minus;thrombus. In: Brilakis E, ed. Manual of percutaneous coronary interventions: a step-by-step approach. Elsevier. 2020;351-361.
20. Collet JP, Montalescot G. The acute reperfusion management of STEMI in patients with impaired glucose tolerance and type 2 diabetes. Diab Vasc Dis Res. 2005;2(3):136-143. doi:10.3132/dvdr.2005.021
21. Nair Rajesh G, Jayaprasad N, Madhavan S, et al. Predictors and prognosis of no-reflow during primary percutaneous coronary intervention. Proc (Bayl Univ Med Cent). 2018;32(1):30-33. doi:10.1080/08998280.2018.1509577
Article available in :
Volume 8, Issue 2, 2025
Page : 345-349
https://doi.org/10.32322/jhsm.16151566
Article Information
Received : 02 Oca 2025
Accepted : 12 Mar 2025
Published : 21 Mar 2025
Corresponding Author :

Ufuk Yıldırım: Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkiye

[email protected]
Citation : Yıldırım U, Çoksevim M, Kara A, Altınbaş A, Başer MH. Predictors of no-reflow after coronary stenting in patients with high thrombus burden. J Health Sci Med. 2025;8(2):345-349.

Read: 0
Cited: 0
Download : 35
_Footer