Management of No-Reflow Phenomenon in the Catheterization Laboratory

JACC Cardiovasc Interv. 2017 Feb 13;10(3):215-223. doi: 10.1016/j.jcin.2016.11.059.


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.

Keywords: ST-segment elevation myocardial infarction; no-reflow; percutaneous coronary intervention.

Publication types

  • Review

MeSH terms

  • Angioplasty, Balloon, Coronary / adverse effects*
  • Animals
  • Cardiac Catheterization / adverse effects*
  • Coronary Circulation / drug effects*
  • Humans
  • No-Reflow Phenomenon / diagnosis
  • No-Reflow Phenomenon / etiology
  • No-Reflow Phenomenon / physiopathology
  • No-Reflow Phenomenon / therapy*
  • Predictive Value of Tests
  • Risk Factors
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / physiopathology
  • ST Elevation Myocardial Infarction / therapy*
  • Treatment Outcome
  • Vasodilator Agents / therapeutic use*


  • Vasodilator Agents