Prevalence and Association of No-Reflow with The Total Ischemic Time in Patients Undergoing Primary Angioplasty

The no-reflow phenomenon is harmful; hence, early diagnosis of its prevalence and predictors is crucial. Few said the time between the first symptom and PCI was a risk factor. After 6 hours of STEMI, myocardial necrosis causes capillary bed edema, cell enlargement, neutrophil clogging, and microvascular dysfunction, causing no-reflow. Objective: To determine the prevalence of the no-reflow phenomenon & its association with total ischemia time among patients of ST-elevation myocardial infarction undergoing primary PCI. Method: After the approval of IERB, a cross-sectional study was conducted at the cardiology department of CEPIC, Multan, using data from 1 September 2023 to 31 March 2024. 300 patients presenting with STEMI or new LBBB <24 hours were enrolled using a non-probability consecutive sampling technique. TIMI flow grade before and after primary PCI, along with the total ischemic time, was calculated (time from chest pain onset to balloon dilatation). The association was calculated using a student t-test through SPSS v26.   Result: The mean age of the study population was 55.06±11.7 years. The incidence of No-reflow in our study population was 46 (15.3%). Regarding the association of no-reflow with TIT, the mean TIT was higher than in the normal TIMI flow showing a significant association ((489.35±387.83 vs 271.437±190.69; p<0.01). Similarly, No reflow as significantly affects the LV ejection fraction. When data was stratified, the association of no-reflow with TIT and LVEF was significant in older age groups, males, diabetics, hypertensives, and smokers. Conclusion: No-reflow is significantly affected by total ischemic time, which in turn affects the left ventricular ejection fraction