Comparison of no-reflow phenomenon in patients with ST-segment- elevation myocardial infarction undergoing primary PCI vs. pharmaco-invasive strategy: a single-centre study.

BACKGROUND: The no-reflow phenomenon after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) represents a major barrier to successful reperfusion, leading to adverse outcomes despite epicardial vessel patency. Comparative evidence regarding its incidence and clinical consequences between primary PCI and pharmaco-invasive PCI remains scarce. AIM: The study aimed to compare the incidence of the no-reflow phenomenon in patients undergoing pharmaco-invasive PCI versus primary PCI, and to evaluate the short-term clinical outcomes of patients with no-reflow at three months post-procedure. METHODS: In this prospective, single centre, observational study, STEMI patients presenting within 24 h of symptom onset were enrolled at a tertiary care centre. Patients experiencing no-reflow were categorized into Group A (primary PCI; n = 92) and Group B (pharmaco-invasive PCI; n = 192). Baseline demographics, comorbidities, angiographic characteristics, and outcomes were analysed. The primary outcome was the incidence of major adverse cardiac events at three months. RESULTS: Among 857 patients undergoing primary PCI and 2,976 undergoing pharmaco-invasive PCI, the incidence of no-reflow was significantly higher in the primary PCI group (10.7% vs. 6.5%). Patients in Group A were older (58.9 ± 13.6 vs. 54.4 ± 11.4 years; P = 0.004) and more frequently diabetic (55.4% vs. 41.6%; P = 0.029), whereas hypertension was more prevalent in Group B (42.7% vs. 13.0%; P < 0.001). Baseline TIMI 0 flow was more common in Group A (79.3% vs. 24.5%; P < 0.001). After PCI, final TIMI 3 flow rates were comparable (85.9% vs. 89.6%; P = 0.361). In-hospital complications and three-month outcomes were similar between two groups: death (4.3% vs. 5.2%), revascularization (4.3% vs. 4.7%), and rehospitalization (5.4% vs. 3.1%) (all P > 0.05). CONCLUSION: No-reflow was more frequent after primary PCI, particularly in older, diabetic, and late-presenting patients with baseline TIMI 0 flow. Both reperfusion strategies achieved comparable short-term clinical outcomes in no-reflow patients. Pharmaco-invasive PCI may mitigate the risk of no-reflow in selected STEMI patients while maintaining equivalent early prognosis.