Predicting No-reflow Based on Angiographic Features of Lesions in Patients with Acute Myocardial Infarction

OBJECTIVES: We tried to elucidate angiographical predictors of no-reflow and to determine a preferable recanalization therapy based on the morphology of lesions. METHODS: Seventy-six patients were randomly assigned into groups to receive primary angioplasty (n = 41) or intracoronary thrombolysis (n = 35). Based on angiography, occlusive infarct-related lesions were divided into thrombus-rich and hard plaque lesions. The outcome of the two therapies used for each lesion was compared. RESULTS: The incidence of no-reflow was higher in the thrombus-rich than hard plaque lesions (38 percent vs. 0 percent, p = 0.006); the left ventricular ejection fraction in the chronic phase was lower (46 +/- 6 percent vs. 55 +/- 5 percent, p < 0.001) for primary angioplasty than thrombolysis. No-reflow was not observed in the hard plaque lesions. However, the incidence of additional reperfusion therapy (88 percent vs. 8 percent, p < 0.001) was higher in the patients who underwent thrombolysis rather than primary angioplasty. CONCLUSIONS: We suggest that thrombus-rich lesions in primary angioplasty may predict no-reflow in acute myocardial infarction, and thrombolysis prior to angioplasty may be preferable for these lesions. We also suggest that primary angioplasty may be more effective than thrombolysis for hard plaque lesions.