PREVENTION OF THE PHENOMENON OF UNRESTORED CORONARY BLOOD FLOW IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION

Sazanov Grigoriy V., Aydemirov Artur Nasirovich, Sapelnikov Oleg V.

The no-reflow phenomenon is the absence or significant reduction of coronary perfusion after successful removal of mechanical obstruction in the epicardial artery, which is manifested by a TIMI blood flow gradation of less than 3 points or a myocardial perfusion index of less than 2 points. Due to the high clinical significance of this problem, methods for preventing no-reflow are actively studied, including pharmacological and mechanical approaches, optimization of percutaneous coronary intervention technique, and patient risk stratification. Timely detection of patients at high risk of developing the no-reflow phenomenon and the use of preventive measures can significantly improve the treatment outcomes for patients with ST-segment elevation acute coronary syndrome (STEMI). Analysis of modern literature has shown that prevention of no-reflow phenomenon is a multifactorial problem requiring an integrated approach at all stages of managing patients with STEMI. The results of large registry studies made it possible to identify the main risk factors for the development of non-restored coronary blood flow. Independent predictors include age over 65 years, diabetes mellitus, arterial hypertension, time from the onset of symptoms to reperfusion of more than 6 hours, damage to the anterior descending artery, high thrombotic load according to the TIMI scale, initially reduced left ventricular ejection fraction of less than 40% and elevated troponin levels. The purpose of this review is to summarize and analyze the most known factors for preventing the phenomenon of non-restored coronary blood flow in patients with STEMI.

Keywords:no-reflow phenomenon, infarction-related coronary artery, acute myocardial infarction with ST-segment elevation