Novel predictors and adverse long-term outcomes of No-reflow phenomenon in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract

Objectives The no-reflow phenomenon occurs in 25% of patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and may be associated with adverse outcomes. The aim of our study was to detect novel predictors of no-reflow phenomenon and the resulting adverse long term outcomes. Methods We enrolled 400 STEMI patients undergoing primary PCI; 228 patients had TIMI flow 3 after PCI (57%) and the remaining 172 patients had TIMI flow <3 (43%). Fibrinogen to albumin ratio (FAR), high sensitive C-reactive protein to albumin ratio (CAR), and atherogenic index of plasma (AIP) were calculated. Long term mortality and morbidity during 6 months follow up were recorded. These data were compared among both groups. Results In multivariate regression analysis, old age (OR = 1.115, 95% CI: 1.032–1.205, P = 0.006), higher troponin level >5.6 ng/mL (OR = 1.040, 95% CI: 1.001–1.080, P = 0.04), diabetes mellitus (OR = 4.401, 95% CI: 1.081–17.923, P = 0.04) and heavy thrombus burden (OR = 16.915, 95% CI: 5.055–56.602, P < 0.001) could be considered as predictors for the development of no-reflow. Interestingly, CAR >0.21, FAR >11.56, and AIP >0.52 could be considered as novel powerful independent predictors (OR = 3.357, 95% CI: 2.288–4.927, P < 0.001, OR = 4.187, 95% CI: 2.761–6.349, P < 0.001, OR = 16.794, 95% CI: 1.018–277.01, P = 0.04, respectively). Higher long term mortality (P < 0.001) and heart failure (P < 0.001) was also strongly related to incidence of no-reflow. Conclusion No-reflow could be attributed to novel predictors as CAR, FAR, and AIP. This phenomenon was associated with long term adverse events as higher mortality and pump failure.

Predictors and Outcomes of No Reflow Phenomenon Post-Primary Coronary Intervention in Young Patient

“…This study showed that admission EF was significantly lower among No Reflow Group. This was in line with Refaat et al (13) who reported that the incidence of no reflow was associated with decreased LVEF on admission (P < 0.001).…”

“…We found that no reflow group significantly associated with Patients with Killip classes 3 and 4 Refaat et al (13) confirmed this finding.…”

“…Refaat et al (13) aimed to detect novel predictors of no reflow phenomenon and the resulting adverse long term outcomes. They confirmed the link between inflammatory mediators and no reflow development.…”

“…The no reflow phenomenon occurs in a considerable number of patients with acute STEMI (25%) undergoing primary reperfusion therapy (3) . Experimental and clinical studies have shown that the no reflow phenomenon is associated with large myocardial necrosis and high mortality (4) .…”

Mortality Outcomes of Single-staged versus Multi-staged Complete Coronary Revascularization in Multivessel Non-ST Elevation Myocardial Infarction Patients

“…In addition, He et al (29), revealed that clinical the SYNTAX score applied grouping patients by risk status for very long-term adverse clinical outcomes undergoing PCI and that predictive precision for 2-year all-cause mortality were improved using the clinical SYNTAX score. There are studies in the literature that demonstrated No-reflow was associated with increased allcause mortality in patients with acute myocardial infarction (30,31). Our study reported comparable findings.…”