Abstract 4144161: The impact of atrial fibrillation on no-reflow phenomenon in acute coronary syndrome patients following percutaneous coronary intervention: A meta-analysis of the current literature

Background: Percutaneous coronary intervention (PCI) is a cornerstone in the management of acute coronary syndrome (ACS) patients. Despite technological advancements, the occurrence of no-reflow phenomenon remains a significant concern among ACS patients. Atrial fibrillation (AF) is a common arrhythmia associated with cardiovascular events. We conducted a meta-analysis to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI. Methods: Relative risk (RR) with a 95% confidence interval (95%CI) served as the summary measure in our meta-analysis using the random-effects model to estimate the summary effect. The primary outcome is to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI. We assigned I2 > 50% as an indicator of statistical heterogeneity. P value <0.05 was considered significant. Data analysis was conducted using SPSS v.25. A comprehensive literature search was performed identifying relevant studies published up to January 2024 from October 2001 from PubMed, Google Scholar, Scopus databases. Studies reporting the baseline AF and no-reflow in ACS patients post-PCI were included. Case reports, duplicate studies, reviews and metaanalysis were excluded. Data screening and analysis were conducted independently by two reviewers. Results: The meta-analysis included 10 studies comprising a total of 11079 ACS patients who underwent PCI. No reflow developed in 2442 of these patients. In total, 653 patients had baseline AF and 10426 patients had not AF. No-reflow developed in 243 of the patients with baseline AF. Also, no-reflow developed in 2199 of the patients with non-AF. Our findings revealed a statistically significant association between AF and increased incidence of no-reflow in ACS patients following PCI (RR: 1.5 Cl %95) (p < 0.05). There was moderate statistical heterogeneity across the studies that evaluated no-reflow outcomes (I2= 61%) Conclusion: In this meta-analysis, we provide evidence suggesting that the presence of AF may have a deleterious effect on the development of no-reflow phenomenon in ACS patients following PCI. AF may have deleterious effects on the coronary microvasculature. Further research is warranted to elucidate the underlying mechanisms and to determine the clinical implications of these observations.