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

  • Joseph AllencherrilEmail author
  • Hani Jneid
  • Dan Atar
  • Mahboob Alam
  • Glenn Levine
  • Robert A. Kloner
  • Yochai Birnbaum
REVIEW ARTICLE
  • 82 Downloads

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.

Keywords

Myocardial infarction Microvascular disease Cardiovascular disease Ischemic heart disease 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that there are no conflicts of interest.

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Authors and Affiliations

  1. 1.Section of Cardiology, Department of MedicineBaylor College of MedicineHoustonUSA
  2. 2.Department of Cardiology B, Oslo University Hospital, and Institute of Clinical SciencesUniversity of OsloOsloNorway
  3. 3.Huntington Medical Research InstitutePasadenaUSA
  4. 4.Division of Cardiovascular Medicine, Department of Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

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