Association and Prognostic Implications of “No-Reflow Phenomenon” and Hypercoagulability in Patients With ST-Segment Elevation Myocardial Infarction

Abstract

Background: Following percutaneous coronary intervention (PCI), the “no-reflow phenomenon” is associated with a worse outcome. However, it remains unclear how to prevent and treat this phenomenon during PCI. Objectives: This study aimed to evaluate the association between thrombogenicity profiles and “no-reflow phenomenon” during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI). Methods: From a real-world registry, we prospectively enrolled patients with STEMI who underwent primary PCI (n = 334). Thrombolysis In Myocardial Infarction flow grade was assessed at final angiography, and the “no-reflow phenomenon” was defined as Thrombolysis In Myocardial Infarction flow between 0 and 2. Thrombogenicity profiles were assessed with thromboelastography (TEG) and conventional hemostatic measurements. Results: Thirty-seven patients (11.1%) showed no-reflow after primary PCI. High platelet-fibrin clot strength (P-FCS: ≥ 68 mm) measured by TEG was significantly associated with an increased risk of post-PCI “no-reflow phenomenon” (OR: 2.611; 95% CI: 1.220-5.584; P = 0.010). The risk stratification with “no-reflow phenomenon” and “high P-FCS phenotype” appeared to be additive to predict the risk of 3-year clinical event (log-rank P < 0.001 across the groups). Patients with both “no-reflow phenomenon” and high P-FCS had a higher risk of adverse clinical events compared with normal-reflow subjects with low P-FCS (adjusted HR: 6.654; 95% CI: 2.678-16.530; P < 0.001). Conclusions: This study demonstrated a close relationship between heightened thrombogenicity (assessed by TEG P-FCS) with “no-reflow phenomenon,” and their additive prognostic implications after primary PCI in STEMI patients. Effective control of clot strength may reduce the risk of “no-reflow phenomenon” and improve clinical outcomes in these patients. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529)