The Progresses Of The No-reflow Phenomenon After Percutaneous Coronary Intervention

The immediate therapeutic goal for acute myocardial infarction is to com- pletely establish the patency of the infarct-related artery. With the emergence of new technology in the field of cardiology, percutaneous coronary inter- vention has become the first line of therapy. However, the successful restora- tion of epicardial coronary artery does not necessarily translate into the impro- vement of tissue perfusion, which is known as the no-reflow phenomenon. The no-reflow phenomenon is defined as inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evi- dence of spasm, stenosis, dissection and embolization in the epicardial coronary artery. The mechanisms of the no-reflow phenomenon are somewhat multifactorial and not fully understood, including demagement of microvas- cular structure, microvascular spasm, obstruction of microvascular, and so on. A combination of these proposed mechanisms induced the no-reflow pheno- menon probably. The risk factors associated with the no-reflow phenomenon include absence of preinfarction angina, hyperglycemia, increasing of some plasma markers, morphology of culprit coronary artery, and operative injury. Patients with the no-reflow phenomenon have a poor clinical prognosis and high mortality. Therefore our attention of treatment has shifted to improve tissue reperfusion. Many drugs have been sufficiently proved effective, such as adenosine, verapamil, dilthiazem, nitroprusside, tirofiban, nicorandil and statins. This article reviews the progresses of the no-reflow phenomenon, regarding to definition, mechanisms, risk factors, intracoronary drugs, and prognosis.