Predictors Of Myocardial No-reflow Following Percutaneous Coronary Intervention:a Meta-analysis

[Background]Primary percutaneous coronary intervention (pPCI) is the preferred treatment for acute myocardial infarction (AMI). In a sizeable portion of patients, however, successful re-opening of epicardial coronary artery does not always mean optimal myocardial reperfusion, known as "slow flow" or "no-reflow". The aim of the study is to identify the clinical factors that predict no-reflow in patients with ST-segment elevated AMI undergoing pPCI.[Methods]Databases including PubMed, Elsevier, Springer-link, and Chinese National Knowledge Infrastructure were searched to identify studies estimating the relationship between no-reflow and AMI in patients undergoing pPCI. Literature qualification estimation combined with meta-analysis was adopted. A fixed or random model was selected depending on the results of heterogeneity test. All statistical tests were performed on Revman5.2and STATA12.0.[Results]A total of18studies including883no-reflow and4758normal reflow cases were identified. Analysis of all studies showed that initial thrombolysis in myocardial infarction (TIMI) flow [Odds ratio (OR)=3.72(95%Confidence Interval (CI):2.90-4.79)], reperfusion time [Mean difference (MD)-0.82(95%CI;0.45-1.19)], and peak creatine kinase (CK) level [MD1087.91(95%CI;795.13-1380.70)] were associated with an increased risk of no-reflow in patients with ST-segment elevated AMI undergoing pPCI.[Conclusions] These findings provide evidence that pPCI patients with low TIMI flow, long reperfusion time and high serum CK level are more likely to develop myocardial no-flow. In addition, due to heterogeneity and wide CIs in this meta-analysis, further research is evidently required.