Abstract 19241: Characteristics of No-Reflow Phenomenon in STEMI Patients Post Thrombectomy: A Multiethnic Group Analysis

Objective: There is limited data about the characteristics of the no-reflow phenomenon in STEMI patients since the introduction of routine thrombectomy. We aimed at studying the characteristics of the no-reflow in multiethnic STEMI patients who underwent primary PCI with thrombectomy. Methods: All patients underwent primary PCI within 6 hours of their presentation. Pre-discharge LVEF was assessed by TTE (3+/-2 days post- MI). Results were then compared between patients who achieved TIMI II and III flow post PCI and the no-reflow group (TIMI 0 and I flow). Results: The 313 patients consisted of (57.2%)Caucasians,(18.5%) Asians,(12.1%) Hispanics,(8.6%) South Asians, and (3.5%)Blacks. No-reflow was seen in 14%(43/313) of patients. Gender distribution (males: 84% vs 79%) and mean age (62.8+/-5.9 yrs vs 61.7+/-6.8 yrs) were similar between the groups. Distribution of traditional risk factors: smoking (44% vs 56%), HTN (72% vs 75%), dyslipidemia (58% vs 71%), DM (30% vs 36%) and incidence of prior CAD (26% vs 25%) were similar in both groups. There were no differences in the distribution of infarct related arteries (prox. and mid LAD-58% vs 48%, RCA-28% vs 37%, LCx-5% vs 9%) in both groups. The no-reflow group had significantly higher serum CPK level on presentation (2154.8 ng/dl vs. 1465.8 ng/dl, p<0.04) and lower LVEF post PCI (44.5% vs 50.3%, p<0.003). However, patients with no-reflow did not have a higher incidence of cardiogenic shock (7% vs 9%), VT/V-fib (2% vs 5%), or IABP requirement (23% vs 21%). Of the ethnic groups, South Asians had significantly higher incidence (16% vs 9%, p<0.05) of no-reflow. In addition, they also presented later (469 minutes vs 179 minutes, p<0.007) and frequently presented with epigastric burning. Conclusions: These data support the hypothesis that the no-reflow phenomenon occurs in a significant proportion of STEMI patients despite primary PCI with thrombectomy. No-reflow resulted in a large infarct size as measured by serum CPK and less early LVEF recovery. However, no-reflow did not result in higher complications during hospitalization. Although no reflow was seen in all ethnic groups, South Asians have a higher incidence of no-reflow phenomenon. This may be attributed to their late presentation and atypical presenting symptoms.