Arq. Bras. Cardiol. 2024; 121(5): e20240119
Inflammation and No-Reflow: Can it be a Game-Changer?
This Short Editorial is referred by the Research article "The Predictive Value of the Inflammatory Prognostic Index for Detecting No-Reflow in ST-Elevation Myocardial Infarction Patients".
No-reflow (NR) is a possible complication during percutaneous coronary intervention (PCI), particularly in the context of ST-segment elevation myocardial infarction (STEMI). It is highly dynamic in nature, develops gradually (over hours) following coronary blood flow restoration, and persists over days to weeks depending on severity, duration, and extent of myocardial ischemia and application of therapeutic measures aiming to prevent or alleviate ischemia/reperfusion injury. NR impacts negatively on the benefits provided by reperfusion therapy and contributes to poor clinical outcomes.,
The main pathophysiological mechanism of NR is microvascular obstruction developing as a consequence of myocardial ischemia, distal embolization, and reperfusion-related injury. The frequency of NR after primary PCI differs widely depending on the sensitivity of the tools used for diagnosis and the timing of examination. Coronary angiography is the most convenient, but it underestimates the true frequency of NR. Cardiac magnetic resonance (CMR) imaging is the most sensitive method in the clinical setting, providing information on the presence, localization, and extent of microvascular obstruction. With CMR, microvascular obstruction is diagnosed in up to 95% of patients with STEMI and restored TIMI flow grade 3, and in 57% of patients with STEMI within 7 days after primary PCI. Other techniques, such as ST-segment resolution and catheter-based coronary physiology tests are less sensitive or technically demanding.
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