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Adjunctive Devices for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

Slide: 7 of 39

Background: The “No-Reflow Phenomenon” After PCI

Dislodgement of atherothrombotic material from coronary lesions during PCI can result in distal embolization that leads to what is commonly referred to as the “no-reflow phenomenon.” This phenomenon, characterized by inadequate flow at the cardiac tissue level despite patent coronary vessels is often defined as: (1) a thrombolysis in MI (TIMI) flow grade ≤2 despite vessel patency and the absence of dissection, spasm, or distal macroembolus; (2) an MBG of 0 or 1; or (3) a contrast perfusion defect observed upon myocardial contrast echocardiography. Depending on the exact clinical definition used, the incidence of no reflow has been found to range from 12 to 39 percent, and may be associated with advanced age, presence of diabetes mellitus, left ventricular systolic dysfunction, longer ischemic times, poor initial TIMI flow grades, and anterior MI. A higher rate of adverse outcomes has been noted in patients with no reflow, including larger infarcts, more significant left ventricular systolic dysfunction, and an increased risk of MACEs or death.