Early revascularization of the infarct-related artery by primary percutaneous coronary intervention (PPCI) has become the gold standard therapy in ST-segment elevation myocardial infarction (STEMI). However, in a number of patient undergoing PPCI, epicardial coronary artery reperfusion: does not translate intomyocardial reperfusion: a phenomenon called as no-reflow. The no-reflow phenomenon has a multifactorial pathogenesis, including: distal embolization, ischemia-reperfusion injury, and individual predisposition of coronary microcirculation to injury. Angiographic and electrocardiographic indexes may be used for the diagnosis. Also, lack of ST-segment elevation resolution is considered an established marker of no-reflow. Importantly, the no-reflow phenomenon provides prognostic information in STEMI patients because it is associated with low ventricular ejection fraction, adverse left ventricular remodelling and mortality at follow-up. Various mechanical devices and pharmacological approaches have been proposed to prevent and to treat the phenomenon: the assessment of mechanisms of no-reflow might guide the development of personalized form of treatment. This paper will be focused on the postulatedmechanisms of the phenomenon, modalities for the diagnosis, and the main treatment options.
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