Despite achievement of optimal epicardial coronary flow in the majority of patients treated for ST-segment elevation
myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI), myocardial no-reflow is a
common phenomenon occurring in 5 to 50% of patients. The no-reflow phenomenon is a predictor of infarct size and an
independent predictor of mortality both in the short and long term. Prevention of no-reflow is therefore a crucial step in
improving prognosis of patients with STEMI. Several strategies including pharmacological and mechanical ones have
been developed to improve microvascular perfusion in the setting of a myocardial infarction. Prevention starts by conservation
of the microvascular reserve especially in patients at high risk of acute coronary syndromes such as diabetes patients.
Optimal glycaemic control and the use of statins have been shown to reduce no-reflow in this context. Reducing
ischaemic time by shortening door to balloon times, administration of intracoronary GP IIb/IIIa antagonists during PPCI
and the use of manual aspiration thrombectomy have been shown to result in better myocardial perfusion and improved
clinical outcome in major trials. In this review we discuss some of these major trials and studies of other therapeutic options
that aim to prevent the no-reflow phenomenon.
Keywords: Myocardial infarction, no-reflow phenomenon, microcirculation, infarct size, pharmacological prevention,
Rights & PermissionsPrintExport