Evidence less cardiology : Is “ No-flow ” better than “ No-reflow ” in STEMI ?

Cath labs are propably the best place to practice preventive cardiology . . . Practice of medicine is primarily guided by Infinite Information , plenty of Intuition, little bit of Intelligence and unquantifiable amount of Ignorance.The science of coronary reperfusion is standing example for variable mix of the above.The term no reflow is a jargan used liberally in cath labs right from first year fellow to super consultant without knowing what exactly they mean by it. What really is No-reflow then ? The academic definition :According to Kloner no-reflow is defined as suboptimal myocardial reperfusion through a part of coronary circulation without angiographic evidence of mechanical vessel obstruction.( Kloner RA, Ganote CE, Jennings RB. “The “no-reflow” phenomenon after temporary coronary occlusion in the dog.” Journal of Clinical Investigation, 1974; 54: 1496–1508.) With due credits to his seminal paper, I always wonder what exactly Dr Kloner meant when he labelled it as No-reflow! No is ok , Flow is ok , What does the adjective “re” mean to you ? Re stands for repeat ? recurrent ? Yes , it may mean any one of it. It may mean nothing in many patients as their post PCI flow is same or found to be no better than pre PCI flow with no significant forward flow at all ! In this situation No-reflow is same as No-flow (Never flown ) in physiological terms irrespective of epicardial patency. Literally, no re-flow telts us , there has been a dramatic procedure rel...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized Source Type: blogs