The No‐Reflow Phenomenon as an Independent Predictor of Contrast‐Induced Acute Kidney Injury and Mortality in STEMI Patients Undergoing Primary PCI

BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) frequently complicates primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). The no-reflow phenomenon, a primary cause of inadequate reperfusion, is linked to systemic inflammation and CI-AKI development. AIMS: This study evaluated the association between no-reflow and CI-AKI, and the subsequent impact on short- and long-term mortality. METHODS: This prospective observational study included 299 STEMI patients undergoing primary PCI. CI-AKI was defined as a serum creatinine increase ≥ 25% or ≥0.5 mg/dL within 48-72 h post-contrast. No-reflow was diagnosed if final distal flow was <TIMI III and/or myocardial blush was absent. RESULTS: CI-AKI occurred in 14.04% (42 patients). These patients were older, had higher inflammatory markers (WBC, CRP), and lower left ventricular ejection fraction. The incidence of no-reflow was significantly higher in the CI-AKI group (73.8% vs. 15.2%, p < 0.001). Multivariate analysis identified the no-reflow phenomenon as an independent predictor of CI-AKI (OR: 10.925, 95% CI: 3.709-32.181, p < 0.001). Furthermore, all-cause mortality was significantly higher in patients with CI-AKI (21.4% vs. 7.4%, p = 0.008), and CI-AKI was independently associated with poor long-term survival. CONCLUSION: The no-reflow phenomenon is a strong, independent predictor of CI-AKI following primary PCI in STEMI patients. Additionally, CI-AKI is independently associated with increased short- and long-term mortality.