Is no-reflow phenomenon predictable before primary or rescue percutaneous intervention in ST elevated myocardial infarction?

Background: During percutaneous coronary intervention if myocardial perfusion is not achieved in coronary artery without dissection, mechanical barriers, distal embolism although the artery responsible for myocardial perfusion is expanded defined as "no-reflow" phenomenon, less current distortion is "slow flow". After acute myocardial infarction, dangerous arrhythmias, congestive heart failure, cardiac death are more common in patients with no-reflow than normal coronary flow patients. Microvascular spasm, endothelial cell injury, inflammation, tissue edema and microvascular plugging of neutrophils in the field are known as important factors in development of no-reflow phenomenon. Identification the risk markers of no-reflow pathophysiology and selection appropriate treatment before the procedure will increase the procedure?s success rate. On the basis of this point, this study points to diagnose high risk patients for no-reflow before primary or rescue percutaneous coronary intervention by examining the patients? demographic characteristics, laboratory parameters and ECGs.Methods: The study involved 173 patients whom primary or rescue percutaneous coronary intervention was applied with diagnosis of ST-elevation acute myocardial infarction in our clinic. Study patients? ECGs, laboratory parameters, demographic data and treatment modalities are obtained from patients? files stored in hospital archive. Patients divided into two groups inclunding no-reflow phenomenon develops and non-develops during procedure. TIMI flow ? 2 specified in the patient?s angiographic catheter report is used as criterion of no-reflow phenomenon. The significance of the difference in parameters mentioned before was evaluated between two groups.Results: Advanced age (p=0.048), female gender (p=0,002), diabetes mellitus (p=0,023), identification of anemia (P=0.005), lymphopenia (p=0.023), blood sugar elevation (p=0.014) in laboratory parameters on admission, long symptom-balloon time (p=0.000), high ST elevation scores (p=0.048), long QT (p=0.023) duration on ECG taken at the application time, treatment with balloon+stent (p=0,048) during the process were found as risk factors for development of no-reflow. These significant parameters evaluated by multiple logistic regression analysis and independent predictors of no-reflow phenomenon have been identified as blood sugar elevation on admission, QT duration, symptom-balloon time, treatment with balloon+stent during process.Conclusion: The occurrence of no-reflow phenomenon before primary or rescue PCI can be predicted by using simple clinical, angiographic and procedural features. Severity of myocardial damage is related to development of the no-reflow phenomenon.Key Words: Acute myocardial infarction; No-reflow phenomenon; Primary percutaneous coronary intervention