Predictors and Outcomes of Slow Flow/No Reflow in Acute Myocardial Infarction Patients Treated with Pharmacoinvasive Strategies

Abstract

Objectives: This study aimed to determine the incidence, predictors, and clinical outcomes of slow flow and no reflow (SF/NR) in patients undergoing a pharmacoinvasive strategy following full-dose thrombolytic therapy for acute myocardial infarction (AMI).

Methodology: We conducted a prospective observational study at the Department of Cardiology, Hayatabad Medical Complex, Peshawar, from February 2022 to February 2023. The study cohort comprised 130 patients who received percutaneous coronary intervention (PCI) after thrombolytic therapy. Comprehensive data on patient demographics, clinical presentations, procedural details, and outcomes were systematically collected. Multivariate logistic regression was employed to identify independent predictors of SF/NR.

Results: The incidence of SF/NR was 13.8%. Significant predictors included hypertension (Odds Ratio [OR]: 2.31, 95% Confidence Interval [CI]: 1.01-5.29, p = 0.047), high thrombus burden (OR: 3.14, 95% CI: 1.38-7.15, p = 0.006), and longer lesion length (OR: 1.29 per mm increase, 95% CI: 1.11-1.50, p < 0.001). Patients with SF/NR experienced significantly higher in-hospital mortality (16.7% vs. 2.7%, p = 0.012), cardiogenic shock (27.8% vs. 5.4%, p < 0.001), heart failure (33.3% vs. 7.1%, p < 0.001), and major adverse cardiac events (MACE) (44.4% vs. 11.6%, p < 0.001). At 30 days post-discharge, the mortality rate was 22.2% in the SF/NR group compared to 4.5% in the normal flow group (p = 0.004).

Conclusion: The study highlights a significant incidence of SF/NR in patients undergoing PCI after thrombolytic therapy for AMI. Identified predictors—hypertension, high thrombus burden, and longer lesion length—underscore the need for targeted risk stratification and management strategies to enhance patient outcomes and mitigate adverse effects.