Elective PCI in non-AMI patients had a 2.4% incidence of no-reflow, independently predicted by atrial fibrillation (OR 2.20), male sex (OR 2.08), and device oversizing (OR 14.4), with smoking inversely associated (OR 0.53).
Cohort (n=3,904)
No
In patients undergoing elective PCI for non-AMI, no-reflow is an infrequent (2.4%) but clinically relevant complication independently predicted by atrial fibrillation, male sex, and stent oversizing.
Effect estimate: OR 2.20 for atrial fibrillation, OR 2.08 for male sex, OR 14.4 for device-to-vessel ratio >1.1, OR 0.53 for current/former smoking (95% CI 95% CI 1.08-4.49 (atrial fibrillation), 1.15-3.74 (male sex), 3.71-56.1 (device-to-vessel ratio), 0.32-0.89 (smoking))
Absolute Event Rate: 2.4% vs 97.6%
p-value: p=0.031 (atrial fibrillation), 0.015 (male sex), <0.001 (device-to-vessel ratio), 0.017 (smoking)
While the ‘no-reflow’ phenomenon is a well-recognized complication of acute myocardial infarction (AMI), its incidence, predictors, and clinical implications in patients undergoing elective percutaneous coronary intervention (PCI) for non-AMI remain insufficiently characterized. We investigated the clinical and procedural predictors of the no-reflow in patients undergoing elective PCI for non-AMI. Among 10,801 patients in a single-center prospective PCI registry (2013–2024), 3,904 patients with non-AMI who underwent elective PCI were included. No-reflow was defined as transient or persistent thrombolysis in myocardial flow 1.1 (OR 14.4, 95% CI 3.71–56.1, p < 0.001), while current or former smoking was inversely associated (OR 0.53, 95% CI 0.32–0.89, p = 0.017). Although ML models were developed to predict no-reflow, their performance was limited owing to the rarity of events. No-reflow is an infrequent but clinically relevant complication of elective PCI for patients with non-AMI. Atrial fibrillation, male sex, and stent oversizing were independent predictors, whereas smoking history was inversely associated. These findings underscore the importance of procedural planning and individualized risk assessment in non-AMI PCI.
Jeon et al. (Tue,) conducted a cohort in Patients undergoing elective percutaneous coronary intervention for non-acute myocardial infarction (n=3,904). Elective percutaneous coronary intervention vs. No-reflow vs no no-reflow groups was evaluated on Incidence of angiographic no-reflow phenomenon defined as TIMI flow grade <3 without mechanical obstruction following elective PCI (OR 2.20 for atrial fibrillation, OR 2.08 for male sex, OR 14.4 for device-to-vessel ratio >1.1, OR 0.53 for current/former smoking, 95% CI 95% CI 1.08-4.49 (atrial fibrillation), 1.15-3.74 (male sex), 3.71-56.1 (device-to-vessel ratio), 0.32-0.89 (smoking), p=0.031 (atrial fibrillation), 0.015 (male sex), <0.001 (device-to-vessel ratio), 0.017 (smoking)). Elective PCI in non-AMI patients had a 2.4% incidence of no-reflow, independently predicted by atrial fibrillation (OR 2.20), male sex (OR 2.08), and device oversizing (OR 14.4), with smoking inversely associated (OR 0.53).