The no-reflow phenomenon in STEMI patients undergoing primary PCI was associated with increased 1-year MACE (40.5% vs. 16.4%; p<0.001) and higher in-hospital mortality (17.3% vs. 4.5%).
Cohort (n=2,925)
Does the no-reflow phenomenon impact short- and long-term outcomes in patients undergoing primary PCI for STEMI?
The no-reflow phenomenon occurs in 18% of STEMI patients undergoing primary PCI and is associated with significantly higher in-hospital mortality and 1-year MACE.
Absolute Event Rate: 40.5% vs 16.4%
p-value: p=<0.001
ABSTRACT Objective To identify clinical and angiographic predictors of the no‐reflow phenomenon and evaluate its impact on short‐ and long‐term outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for ST‐elevation myocardial infarction (STEMI). Methods This retrospective study included 2925 patients who underwent primary PCI for STEMI between January 2020 and July 2025. Patients were stratified into no‐reflow and normal flow groups based on final TIMI flow. Baseline clinical, angiographic, and procedural data were analyzed. Multivariate logistic regression identified independent predictors of no‐reflow. Results The no‐reflow phenomenon occurred in 526 patients (18%). Independent predictors included older age, diabetes mellitus, Killip class ≥ II, high thrombus burden, pre‐PCI TIMI 0 flow, and longer symptom‐to‐door time. Use of GP IIb/IIIa inhibitors was protective. No‐reflow patients had higher in‐hospital mortality (17.3% vs. 4.5%), lower LVEF, and increased 1‐year MACE (40.5% vs. 16.4%). Kaplan–Meier curves confirmed significantly reduced MACE‐free survival (log‐rank p < 0.001). Conclusion The no‐reflow phenomenon is associated with adverse outcomes and can be predicted using routine clinical and angiographic features. Early identification may enable targeted preventive strategies.
Bashir et al. (Mon,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=2,925). No-reflow phenomenon vs. Normal flow was evaluated on 1-year MACE (p=<0.001). The no-reflow phenomenon in STEMI patients undergoing primary PCI was associated with increased 1-year MACE (40.5% vs. 16.4%; p<0.001) and higher in-hospital mortality (17.3% vs. 4.5%).