Does Lesion Location Matter? Ostial LAD Lesions and Risk of No-Reflow during Primary Percutaneous Coronary Intervention

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Objectives: The no-reflow phenomenon during primary percutaneous coronary intervention (PPCI) is a serious complication that limits myocardial reperfusion and worsens clinical outcomes in patients with acute myocardial infarction (AMI). Lesion location, particularly ostial left anterior descending (LAD) artery involvement, may influence the incidence of no-reflow. This study aimed to evaluate the impact of ostial LAD lesions on the occurrence of no-reflow and related in-hospital outcomes in patients undergoing PPCI. Methodology: A prospective cohort of 370 patients with LAD culprit lesions undergoing PPCI was assessed, comprising 101 with ostial lesions and 269 with non-ostial lesions. Clinical presentation, angiographic and procedural characteristics, thrombus burden, Killip class, and outcomes such as thrombolysis in myocardial infarction (TIMI) flow grade, myocardial blush grade, and in-hospital major adverse cardiovascular events (MACE) were compared between groups. Results: Patients with ostial LAD lesions exhibited significantly higher rates of no-reflow (48.5% vs. 18.2%, p < 0.001), increased thrombus burden, and worse ischemic and procedural profiles. Final TIMI flow and myocardial blush grades were lower in the ostial group. In-hospital complications including heart failure (40.6% vs. 22.7%, p = 0.001), recurrent myocardial infarction (18.8% vs. 4.1%, p < 0.001), cardiogenic shock (20.8% vs. 4.8%, p < 0.001), arrhythmias (46.5% vs. 27.1%, p < 0.001), and mortality (17.8% vs. 3%, p < 0.001) were all significantly higher in ostial lesions. Conclusion: Ostial LAD lesions are strongly associated with higher risk of no-reflow, adverse angiographic outcomes, and increased in-hospital morbidity and mortality. Early identification of this high-risk subgroup justifies tailored interventional strategies to optimize reperfusion and improve prognosis in AMI patients.

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