Author + information
- Received August 31, 2016
- Revision received November 7, 2016
- Accepted November 29, 2016
- Published online February 6, 2017.
- Shereif H. Rezkalla, MDa,∗ (, )
- Rachel V. Stankowski, PhDb,
- Jennifer Hanna, MDc and
- Robert A. Kloner, MD, PhDd,e
- aDepartment of Cardiology, Marshfield Clinic, Marshfield, Wisconsin
- bMarshfield Clinic Research Foundation, Marshfield, Wisconsin
- cLund University, Lund, Sweden
- dHuntington Medical Research Institute, Pasadena, California
- eDivision of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Shereif H. Rezkalla, Department of Cardiology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, Wisconsin 54449.
At the conclusion of a primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, and after the cardiologist makes certain that there is no residual stenosis following stenting, assessment of coronary flow becomes the top priority. The presence of no-reflow is a serious prognostic sign. No-reflow can result in poor healing of the infarct and adverse left ventricular remodeling, increasing the risk for major adverse cardiac events, including congestive heart failure and death. To achieve normal flow, features associated with a high incidence of no-reflow must be anticipated, and measures must be undertaken to prevent its occurrence. In this review, the authors discuss various preventive strategies for no-reflow as well as pharmacological and nonpharmacological interventions that improve coronary blood flow, such as intracoronary adenosine and nitroprusside. Nonpharmacological therapies, such as induced hypothermia, were successful in animal studies, but their effectiveness in reducing no-reflow in humans remains to be determined.
Dr. Kloner has received grant funding from Servier, Stealth, and Faraday. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 31, 2016.
- Revision received November 7, 2016.
- Accepted November 29, 2016.
- 2017 American College of Cardiology Foundation