الفهرس 
Acute myocardial infarctionOnly 14 pages are availabe for public view
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Abstract
Restoration of antegrade blood flow in the infarct-related artery
(IRA) and minimize ischemic damage to the myocardium is the goal
of primary percutaneous coronary intervention done for patient
presents by ST-segment elevation acute myocardial infarction
(STEMI).
However, patency of the infarct-related artery does not always
guarantee restoration of normal coronary blood flow as a proportion of
patients develop epicardial coronary artery reperfusion without
myocardial reperfusion after primary PCI, a phenomenon known as
no-reflow which is associated with increased risk of left ventricular
dysfunction, more progressive myocardial damage and higher rates of
morbidity and mortality.
Therefore, the purpose of this study was to recognize clinical, angiographic and procedural features that may predict no-reflow in
patient underwent 1ry PCI aiming at preventing or decrease clinical
impact of this phenomenon.
This study included one hundred patients who underwent
primary percutaneous coronary intervention at the National heart
institute (NHI) and cardiology department, Menoufia University
hospital within the period between January 2016 and June 2016.
All patients were subjected to the following:
- Full history taking.
- Full clinical examination.
- 12-lead ECG.
- Standard coronary angiogram with the assessment of the
following angiographic data: identification of the infarct related artery (IRA), angiographic features of the target lesion, initial
TIMI flow grade, culprit lesion stenosis degree, target lesion
length, reference luminal diameter, thrombus burden (mild,
moderate or high), type of total occlusion if present (tapered or
cut-off lesion), type of subtotal occlusion if present (eccentric or
concentric lesion), length of target lesion and lesion location
(proximal, mid or distal lesion).
All patients were treated by bare metal stents restricted to the
culprit lesion only and platelets glycoprotein IIb/IIIa inhibitors were
used after recognition of coronary anatomy according to the thrombus
burden degree and physician discretion.
Patients were classified into two groups according to the post-
PCI TIMI flow grade: group I included 84 patients with
angiographically documented TIMI flow grade 3 (reflow) and group II included 16 patients with angiographically documented TIMI flow
grade ≤ 2 (no-reflow).
The patient was considered to exhibit a no-reflow phenomenon
if TIMI flow grade in the IRA was 2 or less despite successful
dilatation and absence of mechanical complications such as dissection,
spasm or angiographically evident distal embolization after
completion of the procedure.
The two study groups were compared regarding clinical,
angiographic and procedural data and the following features were
found to be more significant among patients with no-reflow: long time
from onset of symptoms to reperfusion, lower initial TIMI flow grade,
higher thrombus burden on baseline angiography, longer target lesion length and larger reference luminal diameter. So, these factors were
considered to be predictors of no-reflow.