Bibliometric analysis of the no-reflow in ST-segment elevation myocardial infarction patients post-percutaneous coronary intervention: unveiling research trends, collaborative networks, and therapies

Abstract

Background

Insufficient blood flow following percutaneous coronary intervention (PCI) presents a significant challenge in the management of ST-segment elevation myocardial infarction (STEMI). This study aims to provide a bibliometric analysis of the research landscape pertaining to the no-reflow phenomenon in STEMI patients who have undergone PCI.

Methods

A systematic literature search was conducted on the absence of blood flow following STEMI PCI utilizing the Web of Science Core Collection database, covering the period from 2000 to 2025. Bibliometric indicators, co-occurrence analysis, and burst detection were employed through the use of VOSviewer, CiteSpace, and R-bibliometrix tools.

Results

The analysis included 1,101 publications authored by contributors from 60 countries and 1,811 institutions. China led in research output, contributing 255 articles, while Heart Center Leipzig GmbH was the most prolific institution. Thiele H, with an H-index of 26, emerged as the most influential author. Journals such as the European Heart Journal and the Journal of the American College of Cardiology served as key platforms for this research. Keyword analysis revealed a shift in research trends, from early disease- and technique-related terms such as “thrombus”, “aspiration” and “thrombolytic therapy” to recent terms focused on precision medicine, including “enhancement” and “quantification”.

Conclusions

This study comprehensively elucidated global collaboration patterns and the dynamic evolution of research trends in this research field. Keyword analysis revealed a shift in focus from conventional techniques to patient-centered care and personalized treatment strategies in precision medicine. These insights provided valuable guidance for researchers.

Highlight box.

Key findings

• This bibliometric analysis of the no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) patients post-percutaneous coronary intervention (PCI) reviewed 1,101 publications from 60 countries and 1,811 institutions. Keyword analysis showed a shift from early terms like “thrombus”, “aspiration”, and “thrombolytic therapy” to recent terms such as “enhancement” and “quantification,” reflecting a focus on precision medicine.

What is known and what is new?

• The no-reflow phenomenon, defined as insufficient blood flow after PCI in STEMI patients, has been studied mainly through thrombus-related techniques and thrombolytic therapies.

• This analysis highlights evolving keyword trends toward precision medicine and maps global collaboration patterns in no-reflow research.

What is the implication, and what should change now?

• The shift in keywords toward enhancement and quantification signals a move to personalized treatments. Researchers should prioritize precision medicine, including advanced quantification methods, to improve STEMI patient outcomes post-PCI. Enhanced global and interdisciplinary collaboration is crucial to translate these research trends into clinical practice.

Introduction

ST-segment elevation myocardial infarction (STEMI) represents the most severe manifestation of coronary heart disease (CHD), posing a considerable threat to patient health and survival, while concurrently imposing a significant global burden. STEMI is characterized by the abrupt occlusion of a coronary artery, which results in rapid myocardial necrosis and an elevated risk of mortality if not addressed with urgency (1,2). The advent of percutaneous coronary intervention (PCI) has substantially enhanced the prognosis for patients experiencing STEMI; this primary therapeutic modality effectively restores myocardial perfusion (3). PCI not only constitutes the cornerstone of STEMI management but also signifies the advancement of cardiovascular medicine, emphasizing the critical importance of timely revascularization to preserve ischemic myocardium and improve clinical outcomes (3,4).

The no-reflow phenomenon is defined as inadequate blood flow to myocardial tissue, despite the successful resolution of epicardial coronary artery stenosis or occlusion following PCI. This paradox represents a significant challenge within the realm of interventional cardiology (5). In this condition, the microvasculature fails to adequately perfuse the cardiac muscle, which can initiate a cascade of adverse outcomes for patients experiencing STEMI (6). The occurrence of no-reflow is consistently associated with an increase in infarct size, an elevated risk of heart failure, potentially life-threatening arrhythmias, recurrent myocardial infarctions, and increased mortality rates (7). The serious implications of no-reflow on patient outcomes underscore the necessity for healthcare providers to identify individuals at risk and implement strategies aimed at mitigating this complication (7,8). Consequently, it is imperative to comprehend the complex factors contributing to no-reflow in order to refine therapeutic approaches and enhance patient care in STEMI cases.

Bibliometric analysis employs quantitative methodologies to investigate the landscape of scholarly publications. This approach offers a clear and objective overview of research trends, significant publications, and prominent authors and institutions within a specific discipline (9). A notable bibliometric analysis of research on the prognosis of PCI examined a total of 2,666 publications in English and 2,010 in Chinese (10). This analysis delineates the current landscape of PCI prognosis studies and underscores the evolution of research priorities, which have transitioned from a focus on coronary artery disease and PCI itself to the assessment and intervention of risk factors associated with poor outcomes following PCI. The no-reflow significantly impacts patient outcomes after PCI, affecting both treatment efficacy and long-term prognosis (6). Currently, bibliometric studies specifically addressing STEMI and PCI are scarce, with no comprehensive analysis to date exploring the no-reflow phenomenon in STEMI patients post-PCI. This study aims to conduct a systematic bibliometric analysis to thoroughly investigate the research landscape, collaboration patterns, and evolving trends in research hotspots related to the no-reflow phenomenon following PCI in STEMI patients.

Methods

Search strategies and data collection

A comprehensive literature search was conducted using the Web of Science Core Collection (WoSCC) database (11), a robust resource that indexes high-quality, peer-reviewed literature across a wide range of scientific disciplines. WoSCC was selected for this analysis because it is one of the most widely used databases for bibliometric studies, containing numerous high-quality, peer-reviewed journals, and provides detailed citation analysis and author information essential for our collaborative network analysis. While this choice may limit coverage of some regional publications, WoSCC offers standardized data critical for the bibliometric methods employed in this study. To ensure data consistency and mitigate the potential impact of database updates, the search was completed on May 9, 2025. Drawing on prior research (10,12-16), the following search strategy was developed: ((TS = (“ST elevation myocardial infarction” OR STEMI)) AND TS = (“percutaneous coronary revascularization” OR “percutaneous coronary intervention” OR PCI OR “percutaneous transluminal coronary angioplasty” OR PTCA)) AND TS = (no-reflow* OR “microvascular dysfunction” OR “microvascular obstruction” OR “impaired myocardial reperfusion” OR “Slow-Flow Phenomenon” OR “Slow-Flow” OR “Slow Flow Phenomenon” OR “coronary no-reflow”). Two members of the research team meticulously reviewed the search strategy and evaluated the relevance of the retrieved dataset to the research topic. Only “articles” written in English were considered for inclusion in this study. Since all data were obtained from a public database, ethical declarations or approvals were not necessary. The bibliographic information was exported in two formats: “Full record and cited references” to provide a comprehensive dataset, and “plain text” for ease of manipulation and analysis.

Statistical analysis

In this bibliometric analysis, relevant data were extracted from the retrieved literature records, and Microsoft Excel was employed to identify and calculate key bibliometric indicators. VOSviewer (v1.6.20) was utilized for co-occurrence analysis, while CiteSpace (6.3.R1) was employed for keyword burst detection, thereby revealing emerging trends and research hotspots within the field. VOSviewer, a versatile tool, plays a pivotal role in visualizing institutional collaboration, author co-occurrence, citation, and co-citation networks (17). CiteSpace was utilized for keyword burst detection and co-occurrence analysis (18), with parameters established to encompass the period from January 2000 to May 2025, employing a time slice of one year and designating keywords as the node type. The threshold for each time segment was set to the top five keywords, with pathfinder network pruning and merging methods applied. Based on these configurations, a visual analysis was conducted, yielding a keyword timeline for the research area of “no-reflow after PCI in STEMI patients”, thereby highlighting the research dynamics of the field. Additionally, R-bibliometrix (4.4.1), leveraging the computational capabilities of R, provided a robust statistical framework for bibliometric analysis, delivering detailed insights into citation patterns and research impact.

Results

Overview of publications

The analysis revealed that from 2000 to 2025, a total of 1,101 articles were included. These articles were contributed by 6,385 authors from 1,811 institutions across 60 countries or regions, published in 229 journals, and collectively cited 15,733 references (Figure 1). From 2000 to 2025, the annual publication volume showed an overall upward trend, with notable spikes in 2016 and 2022, yielding 84 and 88 articles, respectively. The peak occurred in 2024, with 90 articles. The trend line indicates a clear pattern of sustained growth in this research field since 2007. Note that the 2025 data reflect only the publications recorded up to the search date (Figure 2).

Figure 1.

Flowchart of the literature screening process. The discrepancy in the final count, which is 1,101, is attributed to one article being counted in multiple exclusion categories but excluded only once. PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction.

Figure 2.

Annual number of publications.

Analysis of countries

The analysis showed that from 2000 to 2025, 60 countries/regions published articles in this field. China led with 255 articles, followed by Turkey [116] and Italy [91]. In terms of total citations, Italy ranked first with 3,065 citations, followed by Germany [2,911] and USA [2,731]. However, when citation impact was assessed using normalized metrics, a different pattern emerged. Despite publishing only 14 articles, Norway achieved the highest average citation rate of 53.3 per article, followed by UK (45.1) and Germany (44.1). The proportion of multi-country publications (MCP) reflected international collaboration, with USA and UK tied for first (31 articles each), followed by Italy [23] (Table 1 and Figure 3A).

Table 1. Publication and citation profiles of leading countries.

Country	Articles	FREQ	SCP	MCP	MCP_ratio	TP	TP_rank	TC	TC_rank	Average citations
China	255	0.232	242	13	0.051	693	1	2,489	6	9.8
Turkey	116	0.105	106	10	0.086	353	5	2,119	7	18.3
Italy	91	0.083	68	23	0.253	340	6	3,065	1	33.7
Germany	66	0.06	50	16	0.242	366	4	2,911	2	44.1
USA	66	0.06	35	31	0.47	387	2	2,731	3	41.4
UK	60	0.054	29	31	0.517	379	3	2,709	4	45.1
Netherlands	49	0.045	30	19	0.388	153	8	2,546	5	52
Japan	44	0.04	42	2	0.045	136	11	693	13	15.8
Korea	40	0.036	32	8	0.2	137	10	576	17	14.4
Austria	33	0.03	30	3	0.091	108	13	806	10	24.4
Poland	30	0.027	25	5	0.167	130	12	761	11	25.4
France	26	0.024	20	6	0.231	230	7	612	16	23.5
Spain	23	0.021	18	5	0.217	147	9	640	14	27.8
Australia	21	0.019	14	7	0.333	90	15	383	18	18.2
Denmark	19	0.017	16	3	0.158	81	16	620	15	32.6
Canada	16	0.015	9	7	0.438	75	17	239	20	14.9
Egypt	14	0.013	11	3	0.214	28	26	110	25	7.9
Norway	14	0.013	10	4	0.286	101	14	746	12	53.3
Iran	12	0.011	10	2	0.167	34	22	96	26	8
Serbia	10	0.009	10	0	0	45	20	95	27	9.5

Average citations, the average number of citations per publication; FREQ, frequency of total publications; TC, total citations; TC_rank, rank of total citations; TP, total publications; TP_rank, rank of total publications; MCP, multiple country publications; SCP, single country publications.

Figure 3.

Country distribution and cooperative networking. (A) Distribution of the corresponding author’s publications by country. (B) The visualization map depicts the collaboration among countries. Nodes are countries, sized by publication count. Links show co-occurrence, with thickness indicating collaboration strength. Colors represent research clusters. Link strength reflects co-occurrence frequency. MCP, multiple country publications; SCP, single country publications.

The country co-occurrence network revealed collaboration patterns among nations. Among the 58 countries/regions involved in at least one internationally collaborative article, USA had the highest number of collaborations with other countries (link strength =259), followed by Germany (link strength =137) and UK (link strength =116) (Figure 3B).

Analysis of institutions

As shown in Figure 4A, among the 1,811 institutions involved in this research field, Heart Center Leipzig GmbH published the most articles [84], followed by Leipzig University [82], Medical University of Innsbruck [72], and University of Oslo [72]. The institutional co-occurrence network indicated that, among the 116 institutions with at least five internationally collaborative articles, Leipzig University had the highest number of collaborations with other countries (link strength =123), followed by Cardiovascular Research Foundation and Columbia University (both with link strength =90) (Figure 4B).

Figure 4.

Institutional publication volume and cooperative networking. (A) Top ten institutions by article count and rank. Circle size shows article count. Darker shades indicate higher ranks. (B) The visualization map depicts the collaboration among different institutions. Nodes are institutions, sized by publication count. Links show co-occurrence, with thickness indicating collaboration strength. Colors represent research clusters. Link strength reflects co-occurrence frequency.

Analysis of authors

The H-index and G-index are widely utilized metrics for assessing the impact of prominent authors or collections of publications. As illustrated in Table 2, among the top 20 authors evaluated by H-index, Thiele H achieved the highest H-index of 26, with a G-index of 54, and led in total publications with 61 articles. Eitel I and Desch S followed, with H-indices of 25 and 23, and total publications of 59 and 46, respectively, ranking them among the top three. In terms of total citations, Thiele H ranked first with 2,958 citations, followed by Eitel I with 2,877, and Zijlstra F with 2,037, who had an H-index of 14 and 19 publications. A co-occurrence network analysis was conducted for authors with at least seven publications. Among the 106 authors engaged in international collaborations, Thiele H exhibited the highest link strength [339], followed by Eitel I [338] and Metzler B [283] (Figure 5).

Table 2. Publication and citation profiles of high-impact authors.

Authors	H_index	G-index	M-index	PY_start	TP	TP_frac	TP_rank	TC	TC_rank
Thiele H	26	54	1.368	2007	61	6.02	1	2,958	1
Eitel I	25	53	1.389	2008	59	5.84	2	2,877	2
Desch S	23	43	1.353	2009	46	4.85	3	1,937	4
Schuler G	21	28	1.105	2007	28	2.82	7	1,920	5
De Waha S	20	27	1.25	2010	27	2.71	10	1,896	6
Metzler B	19	32	1.357	2012	38	3.4	4	1,035	9
Fuernau G	18	25	1	2008	25	2.8	12	1,474	7
Reinstadler SJ	17	24	1.545	2015	34	3.08	6	639	18
Banning AP	16	20	1.143	2012	20	1.58	15	913	10
Crea F	16	34	0.889	2008	35	3.33	5	1,176	8
Channon KM	15	19	1.154	2013	19	1.36	17	892	12
De Maria GL	15	22	1	2011	22	1.79	14	871	14
Klug G	15	27	1.071	2012	27	2.35	10	851	16
Dudek D	14	20	0.667	2005	20	1.93	15	891	13
Mayr A	14	23	1	2012	28	2.46	7	556	19
Reindl M	14	21	1.273	2015	28	2.35	7	470	20
Stone GW	14	23	0.609	2003	23	2.06	13	895	11
Zijlstra F	14	19	0.667	2005	19	1.89	17	2,037	3
Gibson CM	13	17	0.542	2002	17	1.5	19	861	15
Kharbanda RK	13	14	1	2013	14	0.99	20	745	17

Average citations, the average number of citations per publication; G_index, the G-index of the journal, which gives more weight to highly-cited articles; H_index, the H-index of the journal, which measures both the productivity and citation impact of the publications; M_index, the M-index of the journal, which is the H-index divided by the number of years since the first published paper; PY_start, publication year start, indicating the year the journal started publication; TC, total citations; TC_rank, rank of total citations; TP, total publications; TP_frac, articles fractionalized; TP_rank, rank of total publications.

Figure 5.

The visualization map depicts the collaboration among different authors. Nodes are authors, sized by publication count. Links show co-occurrences, with thickness indicating collaboration strength. Colors represent research clusters. Link strength reflects co-occurrence frequency.

Analysis of journals

As shown in Table 3, the impact factor (IF) reflects a journal’s academic influence within a particular field, specifically measuring how frequently its published papers are cited in other studies. Among the top 20 journals ranked by H-index, the European Heart Journal (H-index =24, ranked first) had the highest IF of 37.6, followed by the Journal of the American College of Cardiology (H-index =21, ranked second) with an IF of 21.7. The journal co-occurrence network (Figure 6A), which measured the frequency with which two journals were cited together in the same article or reference list, encompassed 96 journals cited at least three times. The three journals with the highest link strengths were Journal of the American College of Cardiology [578], European Heart Journal [468], and International Journal of Cardiology [326], indicating strong thematic connections among their published topics. The journal coupling network (Figure 6B) assessed the degree of association between journals based on shared references in their articles. In this network, the three journals with the highest link strengths were International Journal of Cardiology [29,024], Catheterization and Cardiovascular Interventions [24,089], and American Heart Journal [18,681]. High link strengths suggested that these journals shared a substantial number of references, highlighting a common knowledge base or research focus.

Table 3. Bibliometric indicators of high-impact journals.

Journal	H-index	G-index	M-index	TP	TP_rank	TC	TC_rank	PY_start	IF 2023	JCR 2023
European Heart Journal	24	24	1.2	24	10	2,510	3	2006	37.6	Q1
Journal of the American College of Cardiology	21	24	0.913	24	11	4,321	2	2003	21.7	Q1
American Heart Journal	19	33	0.864	33	4	998	6	2004	3.7	Q1
International Journal of Cardiology	19	30	0.905	60	1	780	8	2005	3.2	Q2
American Journal of Cardiology	17	28	0.654	40	3	1,758	4	2000	2.3	Q2
Catheterization and Cardiovascular Interventions	17	25	0.944	44	2	554	12	2008	2.1	Q3
Jacc-Cardiovascular Interventions	17	19	0.944	19	13	674	9	2008	11.7	Q1
Coronary Artery Disease	13	20	0.722	32	5	280	20	2008	1.5	Q3
Eurointervention	12	20	0.8	24	9	309	17	2011	7.6	Q1
International Journal of Cardiovascular Imaging	12	20	0.857	25	7	188	28	2012	1.5	Q3
Jacc-Cardiovascular Imaging	12	13	1	13	22	620	11	2014	12.8	Q1
Atherosclerosis	11	14	0.647	14	18	207	24	2009	4.9	Q1
Journal of Cardiovascular Magnetic Resonance	11	13	0.611	13	23	348	16	2008	4.2	Q1
Angiology	10	19	0.714	22	12	262	23	2012	2.6	Q2
Clinical Research in Cardiology	10	14	0.588	14	19	140	37	2009	3.8	Q1
Journal of the American Heart Association	10	15	0.714	15	16	264	22	2012	5	Q1
Heart	9	12	0.45	12	26	622	10	2006	5.1	Q1
Journal of Interventional Cardiology	9	15	0.529	15	15	195	26	2009	1.6	Q3
Bmc Cardiovascular Disorders	8	17	0.727	24	8	121	43	2015	2	Q3
Circulation Journal	8	12	0.421	12	25	297	18	2007	3.1	Q2

Average citations, the average number of citations per publication; G_index, the G-index of the journal, which gives more weight to highly-cited articles; H_index, the H-index of the journal, which measures both the productivity and citation impact of the publications; IF, impact factor, indicating the average number of citations to recent articles published in the journal; JCR_quartile, the quartile ranking of the journal in the Journal Citation Reports, indicating the journal’s ranking relative to others in the same field (Q1: top 25%, Q2: 25–50%, Q3: 50–75%, Q4: bottom 25%); M_index, the M-index of the journal, which is the H-index divided by the number of years since the first published paper; PY_start, publication year start, indicating the year the journal started publication; TC, total citations; TC_rank, rank of total citations; TP, total publications; TP_rank, rank of total publications.

Figure 6.

Journal collaboration networks. (A) Co-occurrence networks. Nodes are journals, sized by article count. Links show co-citation in articles, with thickness indicating strength. Colors represent thematic clusters. High link strength implies that the journals are often cited in tandem, indicating a thematic or topical connection between the research they publish. (B) Coupling networks. Nodes are journals, sized by article count. Links show co-citation in articles, with thickness indicating strength. Colors represent thematic clusters. A strong link strength in this context signifies that the journals share a substantial number of references, highlighting a shared intellectual foundation or research focus.

Analysis of keywords

Keyword co-occurrence network analysis revealed that, among 101 keywords with at least 17 occurrences, “reperfusion” was the most central, appearing 280 times with a total link strength of 1,479, followed by “primary angioplasty” (232 occurrences, link strength 1,269), “microvascular obstruction” (192 occurrences, link strength 932), “size” (160 occurrences, link strength 816), and “angioplasty” (157 occurrences, link strength 806) (Figure 7A). Temporal trend analysis highlighted the evolution of research foci. In the early period (2014–2015, blue nodes), studies centered on thrombus management and acute intervention techniques, with key terms including “thrombus”, “aspiration”, and “thrombolytic therapy”. In the mid-term period (2016–2017, green nodes), research shifted toward broader interventions and risk assessment, with prominent terms such as “risk”, “mortality”, “outcomes”, “stent”, and “fractional flow reserve”, while pathological terms like “ischemia” and “myocardial infarction” remained significant. From 2018 onward (yellow nodes), the focus moved to advanced diagnostic techniques and prognostic evaluation, with key terms including “CMR” (cardiac magnetic resonance), “cardiac magnetic resonance”, and “prognostic significance”. Researchers increasingly emphasized the long-term effects of “STEMI” (ST-elevation myocardial infarction) and “clinical implications”, while intervention-related terms such as “enhancement” and “quantification” reflected a growing focus on precision medicine (Figure 7B).

Figure 7.

Visual analysis of keyword co-occurrence network analysis. (A) Keyword co-occurrence network (clusters). Nodes are keywords, sized by frequency. Links show co-occurrence in articles, with thickness indicating strength. Colors represent distinct research clusters based on thematic similarities. (B) Visual analysis of keyword co-occurrence network (time trend). Nodes are keywords, sized by frequency. Links show co-occurrence in articles, with thickness indicating strength. Colors reflect average publication year (see color gradient).

The analysis of keyword citation bursts helped identify key research topics in specific periods, revealing the dynamic evolution of the field. The most prominent citation burst was for “primary angioplasty” (strength 19.52, 2003–2013), which garnered significant attention, followed by “distal embolization” (strength 12.02, 2005–2011). In the 2000s, keywords primarily focused on treatment techniques, including “primary angioplasty” (2003–2013, strength 19.52), “thrombolytic therapy” (2007–2010, strength 7.15), “flow” (2006–2011, strength 7.95), and “perfusion” (2006–2013, strength 5.92). The 2010s saw a shift toward more specific techniques and methodologies, such as “intravenous bolus abciximab” (2014–2016, strength 7.3) and “metaanalysis” (2013–2016, strength 5.14). Notably, keywords in the 2020s included “st segment elevation” (2020–2025, strength 10.39), “index” (2019–2025, strength 6.49), “heart failure” (2020–2025, strength 6.62), “guidelines” (2021–2025, strength 6.49), and “primary PCI” (2022–2025, strength 8.48), which reflected the latest research trends (Figure 8).

Figure 8.

Top 20 keywords with the strongest citation bursts (CiteSpace). In the trend visualization, the blue line shows the duration of citations, and the red segment indicates the duration of citation bursts. PCI, percutaneous coronary intervention.

Discussion

General information

This study employed bibliometric analysis to examine 1,101 cardiovascular research articles on the no-reflow phenomenon following PCI in STEM, authored by 6,385 researchers from 1,811 institutions across 60 countries between 2000 and 2025. The sustained increase in publication volume underscored researchers’ persistent focus on this field. It revealed evolving research trends, from thrombus management to advanced diagnostic techniques. Through comprehensive bibliometric analysis, the study elucidated global collaboration patterns and shifts in research focus, providing valuable insights for guiding future research.

This study highlighted the significant contributions of countries such as China, Italy, and the USA to cardiovascular research, with Norway leading in citation impact. However, despite China role as a major contributor to research output, its citation impact was relatively low, likely due to language barriers and limited innovation in some studies, which constrained their citation potential. In contrast, Norway achieved high citation impact through its unique contributions to precision medicine (19).

Institutions such as Heart Center Leipzig GmbH seemed to benefit from significant government support and access to large patient populations, thereby facilitating the acquisition of valuable datasets for cardiovascular research. The journal analysis indicated that a substantial proportion of studies addressing the no-reflow phenomenon had been published in a select number of high-impact journals, specifically the Journal of the American College of Cardiology and the European Heart Journal. This underscored their considerable influence in shaping academic discourse within this domain. International collaboration has been essential in advancing research within this field. Thiele and colleagues published multiple high-impact studies, achieving significant progress in the research and clinical application of the no-reflow phenomenon (20,21). This interdisciplinary collaboration was imperative for addressing the complex clinical challenges associated with PCI. Future advancements in this area will largely depend on sustained global partnerships and the sharing of resources.

Research hotspots and trends

Keyword co-occurrence networks and citation burst analyses revealed hotspots and evolving trends in cardiovascular research, providing critical insights into the field’s academic dynamics and clinical applications. From the 2000s to the 2020s, research themes shifted markedly from acute intervention techniques to precision medicine. In the 2000s, “primary angioplasty” emerged as a focal point. Ohshima et al. utilized virtual histology intravascular ultrasound (VH-IVUS) to elucidate the no-reflow mechanism, demonstrating that fibrous-fatty plaque components (e.g., necrotic core or dense calcium) and plaque rupture cavity size were closely associated with angiographic no-reflow in STEMI patients post-PCI, with VH-IVUS-assessed cavity volume offering valuable predictive information (22,23). Another study found that elevated plasma osteoprotegerin (OPG) levels at admission in STEMI patients were significantly correlated with post-PCI no-reflow and left ventricular remodeling, serving as a predictive marker (24). Keywords such as “thrombolytic therapy” and “distal embolization” dominated, reflecting a focus on acute treatment and blood flow restoration in STEMI. Grayburn et al. summarized no-reflow issues and optimization strategies, emphasizing the critical impact of the time window on treatment outcomes and improving no-reflow through interventions like platelet inhibitors, mechanical devices, and drug-eluting stents (DES) (25). In the 2010s, research expanded to broader intervention techniques and risk assessment, with keywords like “risk” and “mortality” highlighting attention to treatment efficacy and patient prognosis. A simple risk-scoring system based on clinical variables was developed and validated to predict no-reflow risk in STEMI patients post-PCI (26). This system, based on seven clinical and procedural variables, accurately predicted no-reflow risk, offering an effective tool for early clinical assessment (27). Meanwhile, “intravenous bolus abciximab” and “meta-analysis” indicated refined research methodologies and increased application of evidence-based medicine. Studies supplemented the understanding of no-reflow mechanisms, showing that in STEMI patients with high thrombus burden, merely increasing abciximab dosage or altering administration routes was insufficient to improve platelet aggregation inhibition (PAI) or no-reflow, suggesting the need to explore novel antithrombotic agents or combine precision diagnostics like “CMR” to optimize post-PCI outcomes (28,29). Since 2018, the rise of keywords such as “CMR” (cardiac magnetic resonance), “prognostic significance,” and “clinical implications” signaled a shift toward advanced diagnostic techniques and long-term prognosis evaluation, reflecting the rapid growth of precision medicine in cardiovascular research. Compared to immediate post-PCI coronary angiography, in-hospital “CMR” more accurately predicted STEMI patient prognosis, enabling better risk stratification (30), while novel interventions like sonic thrombolysis offered potential benefits for patient outcomes (19). Additionally, updates to the ESC guidelines on acute coronary syndrome in patients without persistent ST-segment elevation triggered a citation burst for “guidelines” (31), and ongoing updates from the American Heart Association Joint Committee further advanced research (32). These evolving trends provided clear direction for optimizing clinical practice and guiding international collaboration.

Limitations of this study

This study had several limitations. First, the analysis was restricted to quantitative metrics from a specific time period, which failed to capture dynamic changes in publication impact or visibility. Second, the focus on English-language publications introduced language bias, overlooking valuable insights from research published in other languages, thus compromising the global comprehensiveness of the findings. Additionally, the study relied solely on the WoSCC database. Although WoSCC was a comprehensive database widely used for bibliometric analysis, this single-database approach resulted in the omission of publications indexed only in other databases, such as Scopus, PubMed, or EMBASE, excluding relevant literature that could have provided significant perspectives. This limitation was particularly pronounced for publications from regions or institutions with limited representation in WoSCC, which introduced geographic or institutional bias into the findings. Furthermore, the study did not account for author self-citation rates nor further filter the included data to exclude the potential influence of predatory journals, which affected the objective assessment of key contributors’ influence. Future research should eliminate self-citations and establish a more comprehensive review mechanism to ensure a more accurate assessment of influence. Despite these limitations, the study offered valuable insights into research trends and collaboration patterns in the field, highlighting key areas and directions for future investigation.

Conclusions

In conclusion, our bibliometric analysis provided a comprehensive overview, elucidating the global collaboration patterns and dynamic evolution of research trends in the study of the no-reflow phenomenon in STEMI patients undergoing PCI. The no-reflow phenomenon consistently attracted significant attention from researchers. Keyword analysis revealed shifts in contemporary research and practice, highlighting a transition from traditional techniques to patient-centered precision medicine. These insights offered valuable guidance for future research, facilitating a deeper understanding of the no-reflow phenomenon.

Supplementary

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Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.