Prevalence and prognostic implications of the no-reflux phenomenon in patients undergoing primary percutaneous coronary intervention at a university center in a middle-income country

Luis B. Godínez-Córdova, Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Hector González-Pacheco, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Guering Eid-Lidt, Departamento de Cardiología Intervencionista, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Ciudad de México, México
Daniel Manzur-Sandoval, Servicio de Terapia Intensiva Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Rodrigo Gopar-Nieto, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Daniel Sierra-Lara-Martínez, Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad De México, México
José L. Briseño-De-la Cruz, Coronary Care Unit, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, Mexico
Diego Araiza-Garaygordobil, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Salvador Mendoza-García, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Alfredo Altamirano-Castillo, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Alexandra Arias-Mendoza, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México

Objective: To analyze the prevalence of no-reflow and the 30-day mortality in a university center in a middle-income country. Method: We analyzed 2463 patients who underwent primary PCI from January 2006 to December 2021. The outcome measure was 30-day mortality. Results: Of a total of 2463 patients, no-reflow phenomenon was found in 413 (16.8%) patients, 30-day mortality was 16.7 vs. 4.29% (p < 0.001). Patients with no-reflow were older 60 (53-69.5) vs. 59 (51-66) (p = 0.001), with a higher delay in onset of symptom to emergency department arrival 270 vs. 247 min (p = 0.001). No-reflow patients also had had fewer previous myocardial infarction, 11.6 vs. 18.4 (p = 0.001) and a Killip class > 1, 37 vs. 26% (p < 0.001). No-reflow patients were more likely to have an anterior myocardial infarction (55.4 vs. 47.8%; p = 0.005) and initial TIMI flow 0 (76 vs. 68%; p < 0.001). Conclusion: No-reflow occurred in 16.8% of STEMI patients undergoing primary PCI and was more likely with older age, delayed presentation, anterior myocardial infarction and Killip class > 1. No-reflow was associated with a higher mortality at 30-day follow-up.

Keywords: Percutaneous coronary intervention. STEMI. Acute myocardial infarction. No-reflow phenomenon.