Novel insights into no-reflow post-PCI: The predictive value of coronary sinus hemodynamics

Abstract

Background: Coronary no-reflow (NR) represents a significant complication associated with increased mortality in patients with acute myocardial infarction undergoing percutaneous coronary intervention (PCI). The identification of novel predictors for early recognition and timely management warrants investigation in order to improve patient outcomes.

Aim: The coronary sinus has emerged as a versatile tool in various diagnostic and therapeutic interventions. Accordingly, we aimed to measure coronary sinus filling time (CSFT) in patients who developed NR during primary PCI and evaluate its potential role in NR prediction.

Methods: A total of 180 patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI were enrolled in this study. Patients were stratified into two groups based on the occurrence of no-reflow phenomenon: the NR group (n=69) and the normal reflow group (n=111). CSFT was measured following culprit vessel revascularization.

Results: NR developed in 38.3% of patients. CSFT was significantly prolonged in the NR group compared with the normal reflow group (69.13 ± 12.20 vs. 60.19 ± 23.22 frame counts, p=0.001). Regression analysis identified five independent predictors of NR: diabetes mellitus, hypertension, smoking, use of non-compliant balloon, and CSFT. The optimal CSFT cut-off value for predicting NR was >66 frame counts, with a sensitivity of 60.9% and specificity of 78.4%. The area under the receiver operating characteristic curve was 0.722 (p=0.004).

Conclusion: Coronary sinus filling time represents an underutilized yet potentially valuable tool for the prediction and early identification of the no-reflow phenomenon during PCI. Our findings suggest that prolonged CSFT correlates with impaired microvascular perfusion and may serve as an early physiological indicator of impending no-reflow.