Ischemic time is associated with procedure-related no-reflow/slow-flow during perfusion balloon-assisted percutaneous coronary intervention in acute coronary syndrome

Perfusion balloons have been shown to reduce the incidence of no-reflow/slow-flow in thrombotic lesions among patients with acute coronary syndrome (ACS). However, predictors of procedure-related no-reflow/slow-flow during perfusion balloon-assisted percutaneous coronary intervention (PCI) remain poorly defined. We conducted a single-center, retrospective cohort study of patients with ACS who underwent perfusion balloon-assisted PCI following restoration of thrombolysis in myocardial infarction (TIMI) grade 3 flow. The primary outcome was procedure-related no-reflow/slow-flow occurring during any subsequent procedural step after initial flow restoration. A total of 54 patients with ACS were included in the analysis, of whom 9 (16.7%) developed procedure-related no-reflow/slow-flow. When stratified by ischemic time, no-reflow/slow-flow occurred more frequently in patients with an onset-to-PCI time greater than 6 h than in those treated within 6 h (p < 0.01). In multivariate analysis, ischemic time greater than 6 h was associated with procedure-related no-reflow/slow-flow (adjusted odds ratio, 9.79; 95% confidence interval [CI], 1.54–123.41; p = 0.015). The multivariable model demonstrated good discriminative performance, with an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.60–0.99). Among patients with ACS undergoing perfusion balloon-assisted PCI, prolonged ischemic time was associated with procedure-related no-reflow/slow-flow.