YANG Guo-fen,QIAN Chao-qing,BAI Wen-wei.Identification of Risk Factors and Drug Therapy for Postoperative Coronary Artery No-reflow[J].Medical Information,2019,(04):44-46.[doi:10.3969/j.issn.1006-1959.2019.04.016]





Identification of Risk Factors and Drug Therapy for Postoperative Coronary Artery No-reflow
(昆明医科大学第二附属医院心内科1,心血管外科2,云南 昆明 650000)
YANG Guo-fen1QIAN Chao-qing2BAI Wen-wei1
(Department of Cardiology1,Department of Cardiovascular Surgery2,the Second Affiliated Hospital of Kunming Medical University, Kunming 650000,Yunnan,China)
No reflow Percutaneous coronary intervention Diagnosis Medical treatement Mode of administration
Coronary no-reflow (NRP) is a common complication in percutaneous coronary intervention (PCI), especially in emergency PCI. The extent of no-reflow area expands with prolonged revascularization time and is an independent risk factor for prognosis, which can lead to an enlarged infarct size, left ventricular remodeling, arrhythmia or recurrent chest pain and other major adverse cardiac events (MACE). A significant increase. At present, there are a variety of medicinal programs to prevent no-reflow, mainly including sodium nitroprusside, verapamil, tirofiban, adenosine, nicorandil, and anisodamine. Now I will review the judgment and treatment of no reflow.


[1]Wang Y,Wang X,Lau WB,et al.Adiponectin inhibits tumor necrosis factor-alpha-induced vascular inflammatory response via caveolinmediated ceramidase recruitment and activation[J].Circ Res,2014,114(5):792-805.
[2]Ndrepepa G,Tiroch K,Fusaro M,et al.5-year prognostic value of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction[J].Journal of the American College of Cardiology,2010,55(21):2383-2389.
[3]Poon K,Seth M,Dixon S,et al.The clinical implications and predictors of no reflow phenomenon in contemporary PCI:Insights from blue cross blue shield of Michigan cardiovascular collaborative Bmc2[J].J Am Coll Cardiol,2013,61(10):e133.
[4]Soeda T,Higuma T,Abe N,et al.Morphological predictors for no reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction caused by plaque rupture[J].European Heart Journal Cardiovascular Imaging,2017,18(1):103-110.
[5]Gibson CM,Schomig A.Coronary and myocardial angiography:angiographic assessment of both epicardial and myocardial perfusion[J].Circulation,2004,109(25):3096-3105.
[6]Gavin JB,Maxwell L,Edgar SG.Microvascular involvement in cardiac pathology[J].J Mol Cell Cardiol,1998(30):2531-2540.
[7]Klein LW,Kern MJ,Berger P,et al.Society of cardiac angiography and interventions:suggested management of the no-reflow phenomenon in the cardiac catheterization laboratory[J].Catheter Cardiovasc Interv,2003,60(2):194-201.
[8]Zhao S,Qi G,Tian W,et al.Effect of intracoronary nitroprusside in preventing no reflow phenomenon during primary percutaneous coronary intervention:a meta-analysis[J].J Interv Cardiol,2014,27(4):356-364.
[9]Su Q,Li L,Naing KA,et al.Safety and effectiveness of nitroprusside in preventing no-reflow during percutaneous coronary intervention: a systematic review[J].Cell Biochem Biophys,2014, 68(1):201-206.
[10]Xing K,Fu X,Jiang L,et al.Cardioprotective Effect of Anisodamine Against Myocardial Ischemia Injury and its Influence on Cardiomyocytes Apoptosis[J].Cell Biochemistry & Biophysics,2015,73(3):707-716.
[11]Niu X,Zhang J,Bai M,et al.Effect of intracoronary agents on the no-reflow phenomenon during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction:a network meta-analysis[J].BMC Cardiovasc Disord,2018,18(1):3.
[12]Bai S,Fu X,Gu X,et al.Intracoronary administration of different doses of anisodamine in primary percutaneous coronary intervention:protective effect in patients with ST-segment elevation myocardial infarction[J].Coronary Artery Disease,2016,27(4):302-310.
[13]Niccoli G,Rigattieri S,De Vita MR,et al.Open-label,randomized,placebo-controlled evaluation of intracoronary adenosine or nitroprusside after thrombus aspiration during primary percutaneous coronary intervention for the prevention of microvascular obstruction in acute myocardial infarction:the REOPEN-AMI study (Intracoronary Nitroprusside Versus Adenosine in Acute Myocardial Infarction)[J].JACC Cardiovasc Interv,2013,6(6):580-589.
[14]Polimeni A,De Rosa S,Sabatino J,et al.Impact of intracoronary adenosine administration during primary PCI:A meta-analysis[J].Int J Cardiol,2016(203):1032-1041.
[15]Nazir SA,McCann GP,Greenwood JP,et al.Strategies to attenuate micro-vascular obstruction during P-PCI: the randomized reperfusion facilitated by local adjunctive therapy in ST-elevation myocardial infarction trial[J].Eur Heart J,2016,37(24):1910-1919.
[16]Feng C,Han B,Liu Y,et al.Effect of nicorandil administration on myocardial microcirculation during primary percutaneous coronary intervention in patients with acute myocardial infarction[J].Postepy Kardiol Interwencyjne,2018,14(1):26-31.
[17]Yamada K,Isobe S,Ishii H,et al.Impacts of nicorandil on infarct myocardium in comparison with nitrate: assessed by cardiac magnetic resonance imaging[J].Heart & Vessels,2015,3(9):1430-1437.
[19]Soukoulis V,Boden WE,Smith SC,et al.Nonantithrombotic medical options in acute coronary syndromes: old agents and new lines on the horizon[J].Circ Res,2014,114(12):1944-1958.
[20]Wang L,Cheng Z,Gu Y,et al.Short-Term Effects of Verapamil and Diltiazem in the Treatment of No Reflow Phenomenon:A Meta-Analysis of Randomized Controlled Trials[J].Biomed Res Int,2015(2015):382086.
[21]Abdelaziz HK,Elkilany W,Khalid S,et al.Efficacy and safety of intracoronary verapamil versus sodium nitroprusside for the prevention of microvascular obstruction during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction[J].Coron Artery Dis,2017,28(1):11-16.
[22]Abu Arab T,Rafik R,El Etriby,A.Efficacy and Safety of Local Intracoronary Drug Delivery in Treatment of No-Reflow Phenomenon: A Pilot Study[J].J Interv Cardiol,2016,29(5):496-504.
[23]Kolh P,Windecker S,Alfonso F,et al.2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI)[J].Eur Heart J,2014,46(4):517-592.
[24]Ali-Hasan-Al-Saegh S,Mirhosseini SJ,Shahidzadeh A,et al.Appropriate bolus administration of glycoprotein Ⅱb/Ⅲa inhibitors for patients with acute coronary syndromes undergoing percutaneous coronary intervention:intracoronary or intravenous? A comprehensive and updated meta-analysis and systematic review[J].Kardiol Pol,2016,74(2):104-118.
[25]Sun B,Liu Z,Yin H,et al.Intralesional versus intracoronary administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention in patients with acute coronary syndromes:A meta-analysis of randomized controlled trials[J].Medicine (Baltimore),2017, 96(40):e8223.
[26]Aksu T,Guler TE,Colak A,et al.Intracoronary epinephrine in the treatment ofrefractory no-reflow after primary percutaneous coronary intervention: aretrospective study[J].BMC Cardiovascular Disorders,2015,15(1):10.
[27]Zhang CJ,Deng YZ,Lei YH,et al.The mechanism of exogenous adiponectin in theprevention of no-reflow phenomenon in type 2 diabetic patients with acutemyocardial infarction during PCI treatment.[J].Eur Rev Med PharmacolSci,2018,22(7):2169-2174.


 ZHAO Xin-na,LV Xiao-chun,REN Yan-qin.The Study of Postoperative Out-of-hospital Rehabilitation Skills Education for Patients after PCI[J].Medical Information,2018,(04):170.[doi:10.3969/j.issn.1006-1959.2018.12.054]
[2]雷 锐,李 志.冠状动脉介入及替罗非班治疗老年急性心肌梗死并 心源性休克的疗效分析[J].医学信息,2018,(14):150.[doi:10.3969/j.issn.1006-1959.2018.14.046]
 LEI Rui,LI Zhi.Effect of Coronary Intervention and Tirofiban on Elderly Patients with Acute Myocardial Infarction and Cardiogenic Shock[J].Medical Information,2018,(04):150.[doi:10.3969/j.issn.1006-1959.2018.14.046]
[3]杨 震.急性心梗直接介入治疗术中慢血流及无复流的治疗进展[J].医学信息,2019,(06):56.[doi:10.3969/j.issn.1006-1959.2019.06.19]
 YANG Zhen.Progress in the Treatment of Slow Blood Flow and no Reflow in the Treatment of Acute Myocardial Infarction[J].Medical Information,2019,(04):56.[doi:10.3969/j.issn.1006-1959.2019.06.19]

更新日期/Last Update: 2019-03-07