Clinical and Angiographic Predictors of No-Reflow and Its Impact on Outcomes in ST-Elevation Myocardial Infarction: A Retrospective Study.

OBJECTIVE

To identify clinical and angiographic predictors of the no-reflow phenomenon and evaluate its impact on short- and long-term outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).

METHODS

This retrospective study included 2925 patients who underwent primary PCI for STEMI between January 2020 and July 2025. Patients were stratified into no-reflow and normal flow groups based on final TIMI flow. Baseline clinical, angiographic, and procedural data were analyzed. Multivariate logistic regression identified independent predictors of no-reflow.

RESULTS

The no-reflow phenomenon occurred in 526 patients (18%). Independent predictors included older age, diabetes mellitus, Killip class ≥ II, high thrombus burden, pre-PCI TIMI 0 flow, and longer symptom-to-door time. Use of GP IIb/IIIa inhibitors was protective. No-reflow patients had higher in-hospital mortality (17.3% vs. 4.5%), lower LVEF, and increased 1-year MACE (40.5% vs. 16.4%). Kaplan-Meier curves confirmed significantly reduced MACE-free survival (log-rank p < 0.001).

CONCLUSION

The no-reflow phenomenon is associated with adverse outcomes and can be predicted using routine clinical and angiographic features. Early identification may enable targeted preventive strategies.