Which сlinical, laboratory, and instrumental factors are associated with the development of the no-reflow phenomenon in patients with acute coronary syndrome?

Aim. To determine clinical, laboratory, and instrumental factors associated with no-reflow phenomenon in patients with myocardial infarction in the work of cardiology service of the emergency hospital.
Material and methods. A database of 2090 patients diagnosed with acute coronary syndrome and consecutively admitted to a regional vascular center was established for the study. Following percutaneous coronary intervention and assessment of coronary blood flow using the TIMI scale, 59 patients had the no-reflow phenomenon; these patients formed Group 1. Group 2 (n=149) was formed randomly from the remaining 2031 patients with final coronary blood flow TIMI 3. A comparative analysis of clinical, demographic, laboratory, and instrumental data between the two groups was performed, along with an assessment of factors influencing the development of the no-/slow-reflow phenomenon. Statistical analysis was performed using STATISTICA software (data analysis software system), version 10, StatSoft, Inc., using both parametric and non-parametric analysis methods.
Results. In Group 1 diabetes mellitus was observed in 42.4% of patients compared to 22.8% in Group 2, p=0.003. Laboratory tests showed that the mean blood leukocyte count was 10.9×109/L in Group 1 and 9.5×109/L in Group 2, p=0.0015; absolute neutrophil count was 8.4×109/L and 6.6×109/L, respectively, p=0.0003. The mean left ventricular ejection fraction was 42% in Group 1 and 45% in Group 2, p=0.0015. Electrocardiographic changes in the anterior wall of the left ventricle were detected in 59% of Group 1 patients and 50% of Group 2 patients, p=0.018. Proximal lesions of the infarct-related artery were identified in 88% of Group 1 patients and 40% of Group 2 patients, p<0.0001.Binary logistic regression analysis revealed independent risk factors for the development of the no-/slowreflow phenomenon: level of infarct-related artery lesion [OR=3.33; 95% CI: 1.67-6.57; p<0.001], left ventricular ejection fraction [OR=1.1; 95% CI: 1.04-1.17; p<0.001], and time from pain onset to revascularization [OR=1.03; 95% CI: 0.95-0.996; p=0.02].
Conclusion. Prolonged total myocardial ischemia time, the presence of diabetes mellitus, lower left ventricular ejection fraction, elevated blood leukocyte and neutrophil counts, anterior localization of myocardial infarction, and more proximal occlusion of the coronary artery are associated with the development of the no-/slow-reflow phenomenon in patients with myocardial infarction in real clinical practice.

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