No-reflow phenomenon: pathophysiology, diagnosis, prevention, and treatment. A review of the current literature and future perspectives.
No-reflow is responsible for 40% of the primary percutaneous coronary intervention without complete myocardial reperfusion despite successful reopening of the infarct-related artery. This review describes the main pathophysiological mechanisms of no-reflow, its clinical manifestation, including the strong association with increased in-hospital mortality, malignant arrhythmias, and cardiac failure as well as the diagnostic methods. The latter ranges from simple angiographic thrombolysis in myocardial infarction grade score to more complex angiographic indexes, imaging techniques such as myocardial contrast echo or cardiac magnetic resonance, and surrogate clinical end points such as ST-segment resolution. This review also summarizes the strategies of prevention and treatment of no-reflow, considering the most recent studies results regarding medical therapy and devices.
1Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II University, Naples, Italy.
Gennaro
G
Galasso
Stephan
S
Schiekofer
Carolina
C
D'Anna
Giuseppe Di
GD
Gioia
Raffaele
R
Piccolo
Tullio
T
Niglio
Roberta De
RD
Rosa
Teresa
T
Strisciuglio
Plinio
P
Cirillo
Federico
F
Piscione
Bruno
B
Trimarco
D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D062645:Percutaneous Coronary Intervention
ST-segment elevation myocardial infarction; diagnosis; future perspectives; ischemia-reperfusion injury; microvascular obstruction; no-reflow; pathophysiology; prevention; treatment