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Original research
No-reflow phenomenon and comparison to the normal-flow population postprimary percutaneous coronary intervention for ST elevation myocardial infarction: case–control study (NORM PPCI)
  1. Jennifer Ann Rossington1,
  2. Eirini Sol2,
  3. Konstantina Masoura3,
  4. Konstantinos Aznaouridis2,
  5. Raj Chelliah4,
  6. Michael Cunnington1,
  7. Benjamin Davison4,
  8. Joseph John4,
  9. Richard Oliver4 and
  10. Angela Hoye5
  1. 1Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
  2. 21st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
  3. 3Department of Cardiology, Laiko General Hospital, Athens, Attica, Greece
  4. 4Cardiology, Castle Hill Hospital, Hull, UK
  5. 5Department of Academic Cardiology, Hull York Medical School Centre for Cardiovascular and Metabolic Research, Cottingham, UK
  1. Correspondence to Dr Jennifer Ann Rossington; jar{at}


Introduction No-reflow (NR) phenomenon is characterised by the failure of myocardial reperfusion despite the absence of mechanical coronary obstruction. NR negatively affects patient outcomes, emphasising the importance of prediction and management. The objective was to evaluate the incidence and independent predictors of NR in patients presenting with ST-elevation myocardial infarction (STEMI).

Methods This was a single-centre prospective case–control study. Cases were subjects who suffered NR, and the control comparators were those who did not. Clinical outcomes were documented. Salient variables relating to the patients and their presentation, history and angiographical findings were compared using one-way analysis of variance or χ2 test. Multiple regression determined the independent predictors, and a risk score was established based on the β coefficient.

Results Of 173 consecutive patients, 24 (13.9%) suffered from NR, with 46% occurring post stent implantation. Patients with NR had increased risk of in-hospital death (OR 7.0, 95% CI 1.3 to 36.7, p=0.022). From baseline variables available prior to percutaneous coronary intervention, the independent predictors of NR were increased lesion complexity, admission systolic hypertension, weight of <78 kg and history of hypertension. Continuous data were transformed into best-fit binary variables, and a risk score was defined. Significant difference was demonstrated between the risk score of patients with NR (4.1±1) compared with controls (2.6±1) (p<0.001), and the risk score was considered a good test (area under the curve=0.823). A score of ≥4 had 75% sensitivity and 76.5% specificity.

Conclusion Patients with NR have a higher rate of mortality following STEMI. Predictors of NR include lesion complexity, systolic hypertension and low weight. Further validation of this risk model is required.

  • coronary intervention (PCI)
  • acute coronary syndrome
  • interventional cardiology

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  • Contributors JAR: concept, designing, recruiting, collating, data analysis, statistics and writing; ES: recruiting, collating and data analysis; AH: concept, designing and writing: KM: data analysis; KA, MC, BD, RC, RO and JJ: recruiting and protocol.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Written consent was obtained in accordance with the Declaration of Helsinki for contact at 30 days. Patients who failed to survive to hospital discharge were included in the study without consent, as per approval from the Research Ethics Committee (Yorkshire and the Humber-Bradford Leeds (15/YH/0360)), Site Specific Assessment and HEY Trust R&D.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to this study are included in the published text, tables, figures and supplemental material.

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