Abstract
Objectives:To identify the STEMI patients at high risk in terms of no-reflow during percutaneous coronary intervention (PCI) with a simple risk score system that can be used before reperfusion.Methods:Total 173 patients who had undergone primary or rescue percutaneous coronary intervention following the diagnosis of STEMI, were classified as “no-reflow” developers and “no-reflow” non-developers, during the procedure. The pre-procedural ECGs, laboratory parameters, demographic data, time for the treatment, and the treatment methods were evaluated with univariate analysis. The independent predictors were identified by multivariate logistic regression analysis among the no-reflow risk factors. Using the independent predictors, we developed a simple risk score system proportional to area under the ROC (AUROC) curves.Results:The independent predictors of “no-reflow” phenomenon were identified as follows: high values of blood glucose at reference; long symptom-onset-to-balloon-time; and low lymphocyte count. The incidence rates of “no-reflow” in patients with low (0-1), moderate (2-3) and high (4-6) risk factors were 13.3%, 40.0%, and 46.7%, respectively. The risk score system demonstrated a good risk prediction between patients with various risk levels of the development of “no-reflow” with a c-statistics of 0.734 (95% CI 0.654-0.814).Conclusion:The development of “no-reflow” which is an adverse event in STEMI treatment can be predicted efficiently by simple clinical risk scoring method.
Highlights
Acute coronary syndromes including the ST elevation myocardial infarction (STEMI) are the most important conditions of the ischemic heart diseases
Risk factors for the development of “noreflow” were evaluated individually with reference to demographic characteristics, laboratory parameters, ECGs, pre-procedural medicines, initiation of symptoms, treatment, therapies given during the percutaneous coronary intervention (PCI), and STEMI treatment methods (Table-I)
When all of the significant parameters were evaluated with multivariate logistic regression analysis, the independent predictors of “no-reflow” phenomenon were found as follows: high blood glucose levels at admission (OR = 1.008; 95% CI = 1.002, 1.013; p = 0.004), long symptom-onset-toballoon-time (OR = 1.486; 95% CI = 1.248, 1.770; p
Summary
Acute coronary syndromes including the ST elevation myocardial infarction (STEMI) are the most important conditions of the ischemic heart diseases. Increase in invasive interventions in acute coronary syndromes has resulted in newer complications. In percutaneous coronary intervention; the phenomenon of no-reflow is defined as inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evidence of mechanical vessel obstruction. The choice of appropriate treatment by the identification of risk predictors in the pathophysiology of “no-reflow” phenomenon would significantly improve the prognosis of the procedure. In this study, it was aimed to identify the high risk patients before the procedure on the basis of the evaluation of demographics, laboratory parameters, ECGs, symptom-balloon time and the treatment methods of the patients that underwent primary or rescue percutaneous coronary intervention with the diagnosis of STEMI
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