Primary coronary angioplasty in acute myocardial infarction: clinical correlates of the 'no reflow' phenomenon.

The purpose of this study was to assess clinical correlates of the 'no reflow' phenomenon in 21 consecutive patients with acute myocardial infarction and complete occlusion of the infarct related artery (TIMI 0 flow) that underwent successful direct PTCA. After successful recanalization, 11 patients (group I) maintained TIMI 3 flow and ten patients presented with the 'no reflow' phenomenon (Group II). New Q wave on the surface ECG appeared in six patients in group I and in nine patients in group II (P=NS), clinical and radiologic signs of cardiac failure were detected in two patients in group I and in seven patients in group II (P<0.03). Early recurrence of ischemia was reported in three patients of group II but not in group I (P=NS). We conclude that the 'no reflow' phenomenon occurs in about half the cases of direct PTCA for complete occlusion and predicts adverse clinical events.