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Pathophysiology, Diagnosis, and Management of the No-Reflow Phenomenon

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Abstract

Successful reperfusion of an infarct-related coronary artery by primary percutaneous intervention or fibrinolysis during acute ST-elevation myocardial infarction (STEMI) does not always restore myocardial tissue perfusion, a phenomenon termed “no-reflow.” Herein we discuss the pathophysiology of this highly prevalent phenomenon and highlight the most salient aspects of its clinical diagnosis and management as well as the limitations of presently used methods. There is a great need for understanding the dynamic nature of no-reflow, as its occurrence is associated with poor cardiovascular outcomes. The no-reflow phenomenon may lend an explanation to the lack of further improvements in in-hospital mortality in STEMI patients despite decreases in door-to-balloon time. Hence, no-reflow potentially presents an important target for investigators interested in improving outcomes in STEMI.

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Authors and Affiliations

  1. Section of Cardiology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA

    Joseph Allencherril, Hani Jneid, Mahboob Alam, Glenn Levine & Yochai Birnbaum

  2. Department of Cardiology B, Oslo University Hospital, and Institute of Clinical Sciences, University of Oslo, Oslo, Norway

    Dan Atar

  3. Huntington Medical Research Institute, Pasadena, CA, USA

    Robert A. Kloner

  4. Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Robert A. Kloner

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  1. Joseph Allencherril
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Allencherril, J., Jneid, H., Atar, D. et al. Pathophysiology, Diagnosis, and Management of the No-Reflow Phenomenon. Cardiovasc Drugs Ther 33, 589–597 (2019). https://doi.org/10.1007/s10557-019-06901-0

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