Atrial Fibrillation: A Novel Risk Factor for No-Reflow Following Primary Percutaneous Coronary Intervention

Angiology. 2020 Feb;71(2):175-182. doi: 10.1177/0003319719840589. Epub 2019 Apr 8.


There is a lack of evidence regarding the association of atrial fibrillation (AF) and no-reflow (NR) phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI). A total of 2452 patients with STEMI who underwent pPCI were retrospectively investigated. After exclusions, 370 (14.6%) patients were in the AF group and 2095 (85.4%) were in the No-AF group. Patients with a thrombolysis in myocardial infarction flow rate <3 were defined as having NR. Patients in the AF group were older and had higher 3-vessel disease rates (24.1% vs 18.9%; P = .021) and lower left ventricular ejection fraction (45.4 [11.7] vs 48.7 [10.5%]; P < .001). No-reflow rates were higher in the AF group than in the No-AF group (29.1% vs 11.8%; P < .001). According to multivariable analysis, AF (odds ratio: 1.81, 95% confidence interval: 1.63-2.04, P < .001), age, Killip class, anterior myocardial infarction, diabetes mellitus, chronic kidney disease, stent length, and smoking were independent predictors of NR following pPCI. Atrial fibrillation is a quite common arrhythmia in patients with STEMI. Atrial fibrillation was found to be an independent predictor of NR in the current study. This effect of AF on coronary flow rate might be considered as an important risk factor in STEMI.

Keywords: atrial fibrillation; no-reflow; primary percutaneous coronary intervention.

MeSH terms

  • Aged
  • Atrial Fibrillation / complications*
  • Female
  • Humans
  • Male
  • No-Reflow Phenomenon / epidemiology*
  • No-Reflow Phenomenon / etiology*
  • Percutaneous Coronary Intervention*
  • Postoperative Complications / etiology*
  • Postoperative Complications / prevention & control*
  • Retrospective Studies
  • Risk Factors
  • ST Elevation Myocardial Infarction / complications*
  • ST Elevation Myocardial Infarction / surgery*