Frequency of No-Flow in Patients Following PCI in Stable Coronary Artery Disease

Abstract

Background: No-reflow following percutaneous coronary intervention (PCI) is a clinically important complication characterized by impaired myocardial perfusion despite successful epicardial revascularization, and although well studied in acute coronary syndromes, its occurrence and impact in stable coronary artery disease (CAD) remain less clearly defined. Objective: To determine the incidence of no-reflow after elective PCI in stable CAD patients, identify associated clinical and procedural factors, and evaluate short-term clinical outcomes. Methods: This prospective observational study included 100 consecutive patients with stable CAD undergoing elective PCI at a tertiary care center from January to April 2025. No-reflow was defined as final TIMI flow ≤2 in the absence of mechanical obstruction. Baseline clinical, angiographic, and procedural variables were recorded, and patients were followed for 30 days to assess major adverse cardiovascular events. Statistical analysis was performed using SPSS version 22.0, with a p-value <0.05 considered significant. Results: No-reflow occurred in 5% of patients. Higher balloon inflation pressure (16 ± 3 atm vs. 11 ± 2 atm; p=0.01) and use of high-pressure inflation (80% vs. 27.4%; p=0.04) were significantly associated with no-reflow. Post-procedural myocardial infarction was significantly higher in the no-reflow group (60% vs. 2.1%; p=0.03), while re-hospitalization and mortality were numerically higher but not statistically significant. Conclusion: No-reflow is an infrequent but clinically significant complication in stable CAD PCI, strongly associated with procedural factors and increased risk of early adverse outcomes, highlighting the need for careful procedural strategies and early intervention.