Total Ischemic Time and Age as Predictors of PCI Failure in STEMIs: A Systematic Review

Document Type

Peer-Reviewed Article

Publication Date




When feasible, primary percutaneous coronary intervention (PCI) is the definitive intervention for ST-elevation myocardial infarction (STEMI). However, cardiac tissue reperfusion is not always achievable after opening the infarct-related artery. Studies have investigated associating factors and scoring for the “no-reflow” phenomenon. This paper aims to systematically establish the predictive values of total ischemic time and patient age as factors of coronary no-reflow in patients undergoing primary PCI.


A systematic search was performed using EBSCOhost, including CINAHL Complete, Academic Search Premier, MEDLINE with Full Text, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Search results were compiled utilizing Zotero reference manager and exported to for screening, selection, and data extraction by two independent reviewers. The Newcastle-Ottawa Quality Assessment Scale for Cohort Studies was used to evaluate the eight selected studies.


The initial search resulted in 367 articles, with eight meeting the inclusion criteria with a total of 7060 participants. Our systematic review demonstrated that for patients older than 60 years, the odds of the no-reflow phenomenon increased 1.53- 2.53 times. Additionally, patients with increased total ischemic time had 1.147- 4.655 times the odds of no-reflow incidence.


Patients older than 60 years with a total ischemic time >4-6 hours are at higher risk of PCI failure due to the no-reflow phenomenon. Therefore, new guidelines and more research to prevent and treat this physiologic occurrence are essential to improve coronary reperfusion after primary PCI.


Available online 17 June 2023.