No-reflow Group Research Articles

Aortic Arch Calcification in Predicting Unfavorable Angiographic Outcomes for Patients with ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

Despite advances in treatment, no-reflow, large thrombus burden (LTB), and myocardial blush grade (MBG) are associated with adverse cardiovascular outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). Aortic arch calcification (AAC) is associated with subclinical atherosclerosis and adverse cardiovascular events. We aimed to examine the relationship between AAC and unfavorable angiographic outcomes such as no-reflow, MBG, and LTB in STEMI patients undergoing PCI. A total of 269 consecutive patients who presented with STEMI and underwent primary PCI were included in the study prospectively. Patients were divided into 3 groups according to AAC degree: grade 0, grade 1, and grade 2/3. The relationship between AAC and the predictors of unfavorable angiographic outcomes, including LTB, no-reflow, and MBG, was specifically examined. LTB, no-reflow, and MBG 0/1 were significantly higher in the grade 2/3 AAC group compared to the grade 0 and grade 1 groups (all p < 0.05). Moreover, grade 2/3 AAC was found to be an independent predictor for LTB, MBG 0/1, and no-reflow (p = 0.002, p = 0.005, p = 0.004, respectively). Patients were then classified according to thrombus burden, MBG, and no-reflow status. Grade 2/3 AAC was significantly higher than grade 0/1 AAC in the LTB, MBG 0/1, and no-reflow groups (all p < 0.05). AAC can be used as a reliable indicator in predicting no-reflow, MBG 0/1, and LTB in STEMI patients undergoing primary PCI.

The relationship between homocysteine and no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention

Aims: The current study aimed to investigate the relationship between homocysteine and no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention (pPCI).
 Methods: Patients with ST-elevation myocardial infarctions (STEMI) who underwent pPCI in our center between May 01, 2022, and 20 August 2023 were included in this cross-sectional observational study. Patients were classified into two groups according to the occurrence of no-reflow during pPCI. Findings were compared between the two groups.
 Results: A total of 332 patients [male, 75 (%82.8)] with STEMI undergoing pPCI, were included. Among them, 35 (10.5%) patients developed no-reflow. Homocysteine level was significantly higher in the no-reflow(+) group than the no-reflow(-) group [median (IQR), 19.02 (16.11-22.23 vs. 12.45 (10.99-14.93), p=0.019]. According to the multivariate analysis, homocysteine level, TIMI risk score, and postdilatation were independent predictors of no-reflow occurrence [Odds Ratio (95% CI), 1.127 (1.042-1.218), p=0.003, 1.385 (1.157-1.659), p

Predictive effect of triglyceride-glucose index on No-Reflow Phenomenon in patients with type 2 diabetes mellitus and acute myocardial infarction undergoing primary percutaneous coronary intervention

ObjectiveTriglyceride glucose (TyG) index is considered as a new alternative marker of insulin resistance and a clinical predictor of type 2 diabetes mellitus (T2DM) combined with coronary artery disease. However, the prognostic value of TyG index on No-Reflow (NR) Phenomenon in T2DM patients with acute myocardial infarction (AMI) remains unclear.MethodsIn this retrospective study, 1683 patients with T2DM and AMI underwent primary percutaneous coronary intervention (PCI) were consecutively included between January 2014 and December 2019. The study population was divided into two groups as follows: Reflow (n = 1277) and No-reflow (n = 406) group. The TyG index was calculated as the ln [fasting triglycerides (mg/dL)×fasting plasma glucose (mg/dL)/2].Multivariable logistic regression models and receiver-operating characteristic curve analysis were conducted to predict the possible risk of no-reflow. Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) were calculated to determine the ability of the TyG index to contribute to the baseline risk model.ResultsMultivariable logistic regression models revealed that the TyG index was positively associated with NR[OR,95%CI:5.03,(2.72,9.28),p<0.001] in patients with T2DM and AMI. The area under the curve (AUC) of the TyG index predicting the occurrence of NR was 0.645 (95% CI 0.615–0.673; p < 0.001)], with the cut-off value of 8.98. The addition of TyG index to a baseline risk model had an incremental effect on the predictive value for NR [net reclassification improvement (NRI): 0.077(0.043to 0.111), integrated discrimination improvement (IDI): 0.070 (0.031to 0.108), all p < 0.001].ConclusionsHigh TyG index was associated with an increased risk of no-reflow after PCI in AMI patients with T2DM. The TyG index may be a valid predictor of NR phenomenon of patients with T2DM and AMI. Early recognition of NR is critical to improve outcomes with AMI and T2DM patients.

The predictive value of the HALP score for no-reflow phenomenon and short-term mortality in patients with ST-elevation myocardial infarction

ABSTRACT Objective ST-elevation myocardial infarction (STEMI) is a medical emergency demanding immediate intervention, and primary percutaneous coronary intervention (pPCI) is the standard of care for this condition. While PCI has proven highly effective, a subset of patients experience the devastating no-reflow phenomenon, and some face increased short-term mortality. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, a novel biomarker-based tool, has recently surfaced as an innovative predictor of these adverse outcomes. This study aims to investigate the groundbreaking findings that designate a low HALP score as a robust risk factor for no-reflow and short-term mortality in STEMI patients. Methods 1817 consecutive STEMI patients who underwent pPCI were included in this retrospective study, and the patients were divided into two groups according to whether no-reflow developed or not, and the HALP scores of the groups were compared. In addition, short-term mortality was compared between the study groups according to their HALP score values. The predictive ability of the HALP score for no-reflow was evaluated using a receiver operating characteristic curve. Results No-reflow developed in 198 (10.1%) of the patients included in the study. HALP score value was found to be significantly lower in the no-reflow group (27 ± 13 vs 47 ± 24, p < 0.001). After multivariable adjustment, the HALP score was an independent predictor of no-reflow (OR, 0.923, 95% CI, 0.910–0.935, p < 0.001). Furthermore, the HALP score showed good discrimination for no-reflow (AUC, 0.771, 95% CI, 0.737–0.805, p < 0.001). In addition, HALP score was determined to be an independent predictor for short-term mortality (HR, 0.955, 95% CI, 0.945–0.966, p < 0.001). Conclusions HALP score can independently predict the development of no-reflow and short-term mortality in STEMI patients undergoing pPCI.

Utility of electrocardiogram to predict the occurrence of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention (PPCI): a systematic review and meta-analysis.

The no-reflow phenomenon affects about one out of five patients undergoing Primary Percutaneous Coronary Intervention (PPCI). As the prolonged no-reflow phenomenon is linked with unfavorable outcomes, making early recognition is crucial for effective management and improved clinical outcomes in these patients. Our review study aimed to determine whether electrocardiogram (ECG) findings before PCI could serve as predictors for the occurrence of the no-reflow phenomenon. We systematically searched MEDLINE, Scopus, and Embase to identify relevant studies. The random-effect model using inverse variance and Mantel-Haenszel methods were used to pool the standardized mean differences (SMD) and odds ratios (OR), respectively. Sixteen eligible articles (1,473 cases and 4,264 controls) were included in this study. Based on our meta-analysis of baseline ECG findings, the no-reflow group compared to the control group significantly had a higher frequency of fragmented QRS complexes (fQRS) (OR (95% CI): 1.35 (0.32-2.38), P-value = 0.01), and Q-waves (OR (95% CI): 1.97 (1.01-2.94), P-value <0.001). Also, a longer QRS duration (QRSD) (SMD (95% CI): 0.72 (0.21, 1.23), p-value <0.001) and R wave peak time (RWPT) (SMD (95% CI): 1.36 (0.8, 1.93), P < 0.001) were seen in the no-reflow group. The two groups had no significant difference regarding P wave peak time (PWPT), and P wave maximum duration (Pmax) on baseline ECG. Our findings suggest that prolonged QRSD, delayed RWPT, higher fQRS prevalence, and the presence of a Q wave on baseline ECG may predict the occurrence of the no-reflow phenomenon in patients undergoing PPCI.

Predictive value of the triglyceride-glucose index for no-reflow phenomenon after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction complicated by metabolic syndrome.

Acute ST-segment elevation myocardial infarction (STEMI) remains a major contributor to morbidity and mortality worldwide. The no-reflow phenomenon following percutaneous coronary intervention (PCI) complicates the clinical outcome of STEMI. This study aimed to identify a valuable predictor for no-reflow phenomenon. This retrospective study analyzed clinical data from 378 STEMI patients with metabolic syndrome who underwent PCI between January 2023 and December 2023. Patients were divided into normal reflow (n = 311) and no-reflow (n = 67) groups based on post-PCI coronary angiography results. Data collected included patient demographics, medication usage, lipid profiles, cardiac biomarkers, and the triglyceride-glucose (TyG) index. Patients in the no-reflow group were older (59.98 ± 3.45 vs. 58.69 ± 3.57 years, P = 0.007), with higher fasting glucose (118.57 ± 7.23 vs. 113.59 ± 7.62 mg/dL, P < 0.001) and triglycerides (185.36 ± 10.17 vs. 176.56 ± 10.38 mg/dL, P < 0.001). The TyG index was notably higher in the no-reflow group (8.97 ± 1.15 vs. 7.49 ± 1.17, P < 0.001), showing the strongest correlation with no-reflow (r = 0.420, P < 0.001). Receiver Operating Characteristic (ROC) analysis identified the TyG index as the best predictor, with an AUC of 0.818 at a threshold of 8.1. Multivariable logistic regression identified TyG index ≥ 8.1 as the strongest independent predictor of no-reflow (OR, 9.591; 95% CI, 4.469-20.587, P < 0.001). The AUC of the TyG for predicting no-reflow was 0.869, with specificity and sensitivity of 0.891 and 0.791, respectively. The TyG index is a powerful predictor of the no-reflow phenomenon in STEMI patients with metabolic syndrome undergoing PCI. Its robust sensitivity and specificity underscore its utility for risk stratification, enabling clinicians to identify high-risk patients and tailor preventive strategies.

A new predictor of coronary no-reflow phenomenon after percutaneous coronary intervention in saphenous vein grafts: Eisonophil

Introduction: Coronary no-reflow phenomenon is an important factor that causes increased mortality and morbidity in percutaneous coronary intervention procedures. How this happened is a subject that is still under investigation and has no clear answer. In this study, we examined the effect of eosinophil values in coronary no-reflow. Methods: The study was designed retrospectively. Four hundred four patients who underwent coronary bypass were included in the study; 153 in the no-reflow group and 251 in the regular coronary flow group. The relationship between eosinophil values and no-reflow was examined. Results: In the examination between no-reflow and eosinophil, there was a significant difference between the groups (p &lt;0.001), Multivariate analysis showed that presence of coronary stent (p = 0.001), diabetes mellitus (P = 0.001), neutrophils (P = 0.001), eosinophil (P = 0.001) were effective coronary no-reflow phenomena. Conclusions: Many factors play a role in developing no-reflow and eosinophil height among these factors. It should be kept in mind that no-reflow may develop if eosinophil elevation is present in coronary artery disease.

Analysis of risk factors for PCI no-reflow in coronary heart disease and construction of related prediction models.

To analyze the risk factors of percutaneous coronary intervention (PCI) no-reflow in patients with coronary heart disease (CHD) and construct a predictive nomogram model. This retrospective study included 260 patients with CHD who underwent PCI in the Third Affiliated Hospital of Chongqing Medical University from January 2022 to December 2023. The subjects were divided into a PCI no-reflow group (n = 86) and normal reflow group (n = 174) based on thrombolysis in myocardial infarction (TIMI) blood flow grading. General data, PCI related data and laboratory indexes of patients were collected. Logistic regression was used to analyze the risk factors of no-reflow after PCI in CHD patients. Based on the significant variables from regression analysis, a nomogram prediction model was constructed by using R language. The accuracy of the model was evaluated by receiver operating characteristic (ROC) curve and calibration curve, and the decision curve was drawn to clarify the clinical utility of the model. Model performance metrics included area under the curve (AUC), accuracy, sensitivity and specificity. Multivariate logistic regression analysis showed that hypertension, cystatin C (Cys-C), hypersensitive c-reactive protein (hs-CRP) and platelet-to-lymphocyte ratio (PLR) were risk factors for no-reflow after PCI in CHD patients (OR > 1, P < 0.001), while ADAM metallopeptidase with thrombospondin type 1 motif 13 (ADAMTS-13) and lymphocyte (LYM) were protective factors (OR < 1, P < 0.001). The nomogram prediction model based on the above risk factors showed good predictive value. The AUC of the nomogram prediction model in the training set was 0.967 (95% CI: 0.946-0.989), with a specificity of 0.923 and a sensitivity of 0.908. In the validation set, the AUC was 0.894 (95% CI: 0.817-0.971), with a specificity of 0.807 and a sensitivity of 0.857. The calibration curve indicated good agreement between the predicted and actual probabilities, and the decision curve showed clinical benefit across a range of threshold probabilities in both the training and validation sets (0.0-0.99). The risk factors affecting the occurrence of no-reflow after PCI in patients with CHD include hypertension, serum Cys-C, hs-CRP, PLR, ADAMTS-13 and LYM levels. The nomogram risk prediction model based on the above factors is valuable for identifying patients with high risk of no-reflow after PCI.

Association of Total Ischemia Time with No-Reflow Phenomenon in Patients Presenting with STElevation Myocardial Infarction, Undergoing Primary Percutaneous Coronary Intervention

Objective: To find out the association of total ischemic time with no-reflow phenomenon, in terms of Thrombolysis in Myocardial Infarction (TIMI) flow grade, in patients presenting with ST-Elevation Myocardial Infarction and undergoing Primary Percutaneous Coronary Intervention(PPCI). Study Design: Analytical Cross-Sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan, from Nov, 2022 to Jan, 2023. Methodology: This analytical cross-sectional study was conducted on n=184 patients, recruited through consecutive sampling technique to collect data prospectively. Patients were divided into no-reflow and normal flow group. Patients’ total ischemic time was documented and pre &amp; post-procedural TIMI flow was noted. SPSS version-24:00 was used to enter and analyze data. Chi-square, Fisher exact test and t-test were applied and p-value≤0.05 was taken as statistically significant. Results: Out of 184 study participants, 17(9.2%) were females as compared to 167(90.8%) males. The mean age was 60.23±10.28 years. No-reflow phenomenon was observed in 20(10.9%) patients. The mean age was higher in the no-reflow group than that of the normal flow group (62.65±11.61 vs 59.94±10.12 years). Total ischemic time, pre &amp; post-procedural TIMI flow were found to be significantly associated with no-reflow phenomenon (p&lt;0.05). Conclusion: There exists a strong association between total ischemic time and the occurrence of no-reflow phenomenon. Patients with delayed reperfusion present with greater frequency of no-reflow and low TIMI grade and vice versa.

R wave peak time and no reflow following primary percutaneous coronary intervention: Immediate and short-term outcomes.

No reflow (NR) remains an important constraint in management of ST elevation myocardial Infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Most ECG parameters validated till date including ST resolution are postprocedural. R wave peak time (RWPT) is a dynamic parameter and reflects conduction delay in ischaemic myocardium in selected leads supplied by infarct related artery (IRA). The present study was undertaken to see whether preprocedural RWPT per se or RWPT following primary PCI can predict persistence of NR along with immediate and short-term clinical outcome. 200 patients were enrolled after exclusion. Clinical, Biochemical, ECG parameters including RPWT and angiographic parameters (pre- and post-procedure) were recorded. ECG papers was analysed using digital image processing software (http://imagej.nih.gov/ij/). All patients were followed up for 6months. NR was observed in 35% of the patients. Age, Diabetes, symptom to balloon time, higher thrombus burden, peak CPK-MB level (pre and post procedure) were significantly higher in NR group. On ECG analysis, baseline RWPT, QRS duration and pathological Q wave were significantly higher in NR group. On multivariate analysis, age (OR 1.10 CI 1.00-1.21 P=0.04), thrombus grade≥3 in IRA (OR 12.38 CI 2.08-73.58 P=0.006), symptom to balloon time (OR 2.18 CI 1.6-3.0 P<0.001) and baseline RWPT on ECG [OR 1.86 CI 1.24-2.78, P=0.003] were found to be independent predictors of NR. Increase in RWPT following primary PCI was found to both highly sensitive and specific for diagnosing persistence of NR after primary PCI. Follow up at the end of 6months has shown that patients with increased RWPT following primary PCI had worse short-term cardiovascular outcomes compared to those with decreased RWPT following primary PCI. Baseline RWPT is a significant predictor of NR in patients of STEMI undergoing primary PCI. A persistently increased RWPT following primary PCI is also a highly sensitive and specific ECG marker of persistence of NR which is associated with adverse short-term clinical outcome.

Comparison of the Effect of Clopidogrel and Ticagrelor on the Development of No-Reflow Phenomenon After Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

Background: No-reflow phenomenon (NRP) is one of the most important factors affecting myocardial reperfusion. Objective: In this study, we investigated the effect of ticagrelor and clopidogrel on the development of NRP in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods: Our single-center, retrospective study included 200 patients with AMI who underwent PCI. The patients were divided into two groups according to the antiplatelet regimen given before PCI: clopidogrel- and ticagrelor-loaded groups. NRP was defined based on TIMI flow classification or post-procedural ST segment resolution. The difference in the parameters between patients with no-reflow and patients with normal flow as well as the effect of ticagrelor and clopidogrel on NRP were evaluated. Results: There was no difference in baseline characteristics between patients with no-reflow and patients with normal flow. The number of patients with ST-elevation myocardial infarction was higher in the ticagrelor-loaded group compared with the clopidogrel-loaded group (P = 0.013). Age, aspartate aminotransferase (AST), C-reactive protein (CRP), peak creatine kinase MB (CK-MB), diabetes mellitus (DM) rate, length of stent, number of stents, and number of patients with low ejection fraction were significantly higher in the no-reflow group compared with the normal flow group. The rate of NRP development was significantly lower in ticagrelor-loaded patients (19% P = 0.001), independent of other independent variables, including age, DM, AST, CRP level, number of stents implanted, and type of myocardial infarction (odds ratio = 0.228, 95% confidence interval = 0.102–0.512, P &lt; 0.001). Conclusion: Ticagrelor is superior to clopidogrel in preventing the development of NRP.

CHA2DS2 - Vasc Score Predict No Reflow Phenomenon in Primary Percutaneous Coronary Intervention

Purpose: ST-Elevation Myocardial Infarction is the most acute manifestation of Coronary artery disease, with substantial morbidity and mortality. Early reperfusion (re-establishing the blood flow in the occluded artery) is the most effective way to preserve the viability of the ischaemic myocardium and limit infarct size. Early diagnosis of STEMI is crucial to initiate appropriate treatment and should ideally be made within 10 minutes of first medical contact. This study aimed to evaluate the CHA2DS2-VASc score as a simple tool for predicting the no-reflow among patients with STEMI who underwent primary percutaneous coronary intervention.&#x0D; Methodology: This was a case-control study which was conducted on 100 patients, diagnosed with acute STEMI and underwent primary PCI, who was admitted to Cardiology Department, Benha University Hospital and National Heart Institute. Patients were classified into two groups, control and no-flow, according to their final angiographic TIMI flow rates resulting from primary PCI. The control group: 78 patients with TIMI flow rate &gt;2. The no-reflow group: 22 patients with TIMI flow rate ≤2, despite mechanical reopening of the infarct-related artery in patients without dissection of the coronary artery.&#x0D; Findings: In this study, LVEF was significantly lower in patients with no-reflow compared to patients with normal TIMI flow (p &lt;0.001), but LVEDV was significantly higher (p =0.01). There was no significant difference in LVESV between patients with no-reflow compared to patients with normal TIMI flow. CHA2DS2VASC score was significantly higher in patients with no-reflow compared to patients with normal TIMI flow (p &lt;0.001). CHA2DS2VASC score is a significant predictor of occurrence of no reflow phenomenon (AUC: 0.689, p =0.006). At a cut off value of ≥ 2it has a sensitivity of 68.2%, specificity of 58.9%, PPV of 31.9% and NPV of 86.8%.&#x0D; Recommendation: The study suggest that the CHA2DS2‑VASc score can be an independent predictor of no‑reflow phenomenon in patients undergoing primary PCI. As a simple and easy‑to‑calculate score, it might be a useful assessment tool to predict no‑reflow phenomenon before primary PCI interventions in patients with STEMI. Thus we recommend using CHA2DS2-VASc score as it is very simple and a quick tool to predict no-reflow before primary PCI

Machine learning prediction of no reflow in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

No-reflow (NRF) phenomenon is a significant challenge in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Accurate prediction of NRF may help improve clinical outcomes of patients. This retrospective study aimed at creating an optimal model based on machine learning (ML) to predict NRF in these patients, with the additional objective of guiding pre- and intra-operative decision-making to reduce NRF incidence. Data were collected from 321 STEMI patients undergoing pPCI between January 2022 and May 2023, with the dataset being randomly divided into training and internal validation sets in a 7:3 ratio. Selected features included pre- and intra-operative demographic data, laboratory parameters, electrocardiogram, comorbidities, patients' clinical status, coronary angiographic data, and intraoperative interventions. Post comprehensive feature cleaning and engineering, three logistic regression (LR) models [LR-classic, LR-random forest (LR-RF), and LR-eXtreme Gradient Boosting (LR-XGB)], a RF model and an eXtreme Gradient Boosting (XGBoost) model were developed within the training set, followed by performance evaluation on the internal validation sets. Among the 261 patients who met the inclusion criteria, 212 were allocated to the normal flow group and 49 to the NRF group. The training group consisted of 183 patients, while the internal validation group included 78 patients. The LR-XGB model, with an area under the curve (AUC) of 0.829 [95% confidence interval (CI): 0.779-0.880], was selected as the representative model for logistic regression analyses. The LR model had an AUC slightly lower than XGBoost model (AUC 0.835, 95% CI: 0.781-0.889) but significantly higher than RF model (AUC 0.731, 95% CI: 0.660-0.802). Internal validation underscored the unique advantages of each model, with the LR model demonstrating the highest clinical net benefit at relevant thresholds, as determined by decision curve analysis. The LR model encompassed seven meaningful features, and notably, thrombolysis in myocardial infarction flow after initial balloon dilation (TFAID) was the most impactful predictor in all models. A web-based application based on the LR model, hosting these predictive models, is available at https://l7173o-wang-lyn.shinyapps.io/shiny-1/. A LR model was successfully developed through ML to forecast NRF phenomena in STEMI patients undergoing pPCI. A web-based application derived from the LR model facilitates clinical implementation.

The Association Between No-Reflow and Serum Uric Acid/Albumin Ratio in Patients With Acute Myocardial Infarction Without ST Elevation.

This study evaluated the association between no-reflow (NR) and serum uric acid/albumin ratio (UAR) in 360 consecutive patients with non-ST-elevation myocardial infarction (NSTEMI) undergoing primary percutaneous coronary intervention. The study population was divided into two groups as follows: reflow (n = 310) and NR (n = 50) group. The thrombolysis in myocardial infarction (TIMI) flow score was used to describe NR. High UAR (Odds Ratio: 3.495, 95% CI; 1.216-10.048; P < .001) was found to be an independent predictor of NR. Additionally, UAR was positively correlated with the SYNTAX score and neutrophil/lymphocyte ratio; UAR was negatively correlated with left ventricular ejection fraction. The highest cut-off ratio of UAR predicting NR was found to be 1.35 with 68% sensitivity and 66.8% specificity. The area under the curve (AUC) for UAR was .768 (95% CI: .690-.847) after receiver operating characteristic (ROC) curve assessment. The AUC for UAR was found to be higher than for its components: serum uric acid (AUC: .655) and albumin (AUC: .663) (P < .001 for each evaluation).

Predictive value of C-reactive protein/albumin ratio for no-reflow in patients with non-ST-elevation myocardial infarction.

Introduction: The focus of this research was to explore the link between CRP (C-reactive protein) /albumin ratio (CAR), a novel inflammatory response marker, and no-reflow (NR) phenomena in non-ST elevation myocardial infarction (non-STEMI) patients during percutaneous coronary intervention (PCI). Methods: The current study recruited 209 non-STEMI participants who underwent PCI. The patients were divided into two groups based on their post-intervention Thrombolysis in Myocardial Infarction (TIMI) flow grade; those with and without NR. Results: In all, 30 non-STEMI patients (6.9%) had NR after PCI. CAR values were substantially greater in the NR group. The CAR was identified to be a determinant of the NR (OR: 1.250, 95% CI: 1.033-1.513, P=0.02), although CRP and albumin were not independently related with NR in the multivariate analysis. In our investigation, low density lipoprotein-cholesterol levels and high thrombus burden were also predictors of the occurrence of NR. According to receiver operating characteristic curve evaluation, the optimal value of CAR was>1.4 with 60% sensitivity and 47% specificity in detecting NR in non-STEMI patients following PCI. Conclusion: To the best of knowledge, this is the first investigation to demonstrate that the CAR, a new and useful inflammatory marker, can be utilized as a predictor of NR in patients with non-STEMI prior to PCI.

Abstract 13925: Initial Triglyceride Glucose Index as a Predictor of No-Reflow After Primary Percutaneous Coronary Intervention

Introduction: The triglyceride glucose (TyG) index is a screening method for insulin resistance that can be used on a daily clinical basis and only requires two laboratory determinations: serum triglycerides and serum glucose. Prospective studies of predictive values of the TyG index for cardiovascular diseases (CVD) have primarily focused on pre-existing coronary arterial disease or diabetes mortality, and the TyG index has been shown to be associated with subclinical atherosclerosis symptoms, such as arterial stiffness and preclinical coronary arterial calcification. The study aimed to investigate the possible correlation between the TyG index and the no-reflow phenomenon in patients presented with acute STEMI undergoing primary percutaneous coronary intervention (PPCI). Methods: A total number of 702 patients who presented with acute STEMI in the period from 1/9/2015 to 1/9/2019 who underwent PPCI according to the standard techniques were included. Patients with a previous history of diabetes, dyslipidemia, or on statin therapy were excluded from the study. Initial triglyceride levels as well as fasting blood glucose were tested in all patients at the time of admission. TyG index was calculated for all patients. No-reflow was defined as distal Thrombolysis in Myocardial Infarction (TIMI) flow less than III. Results: 618 patients (88 %) had normal flow while 84 patients (12%) had no-reflow. The mean TyG index was 4.3±0.4 in the no-reflow group versus 4.2±0.4 in the normal reflow group (P = 0.03). After propensity matching, the mean TyG index was 4.2 ± 0.3 in both groups. (P = 0.99) Conclusion: In a retrospective observational study, there was no statistically significant difference between no-reflow and normal flow groups after propensity matching. Further research is required to detect whether the TyG index can be used as a readily available independent predictor of cardiovascular morbidity and mortality.

Correlation between endothelial dysfunction and occurrence of no-reflow in patients undergoing post-thrombolysis early invasive percutaneous intervention for ST-elevation myocardial infarction

BackgroundEndothelial dysfunction and no-reflow share microcirculatory obstruction as a common pathophysiological mechanism. This study evaluated the relationship between systemic peripheral endothelial dysfunction assessed by flow-mediated dilatation (FMD) of the brachial artery and no-reflow in patients with ST-segment elevation myocardial infarction (STEMI) who received successful fibrinolysis.ResultsThis study included 150 patients managed by the percutaneous coronary intervention (PCI) after successful fibrinolysis. Patients were divided according to coronary angiographic success into normal flow versus no-reflow groups. According to FMD measured through brachial artery ultrasound, patients were divided based on their endothelial function into endothelial dysfunction versus normal endothelial function. No-reflow occurred in 44 patients (29.3%). No-reflow patients had longer pain to door time (6.52 ± 1.82 vs 5.19 ± 1.85 h), more Killip class II (36.4% vs 16%, p = 0.006), and lower FMD (7.26 ± 1.92 vs 8.23 ± 2.76%, p = 0.036). Also, they showed more endothelial dysfunction; however, this difference was statistically nonsignificant (97.7% vs 87.7%, p = 0.055). One hundred and thirty-six patients (90.7%) had endothelial dysfunction. They were older (57.51 ± 5.92 vs 50.86 ± 4.55 years, p value ≤ 0.001), more smokers (41.2% vs 14.3%, p = 0.04). Patients with normal endothelial function had a more myocardial blush grade (MBG) 3 (78.6% vs 26.5%, p value = 0.001) in comparison with more MBG 2 in those with endothelial dysfunction (41.9% vs 14.3%, p value = 0.001). Endothelial dysfunction patients had nonsignificant more no-reflow (31.6% vs 7.1%, p-value: 0.06). There was a significant weak positive correlation between thrombolysis in myocardial infarction (TIMI) flow and FMD (r = 0.174, p = 0.033) and a significant moderate positive correlation between MBG and FMD (r = 0.366, p < 0.001). Patients with TIMI I flow had significantly lower FMD compared with patients with TIMI II and TIMI III flow post-PCI. FMD ≤ 6% could predict post-procedural TIMI I flow.ConclusionsIn STEMI patients who underwent PCI within 24 h after successful fibrinolysis, those who had no-reflow showed worse peripheral systemic endothelial function as they had lower brachial artery FMD. Also, FMD showed a significant positive correlation with the post-procedural angiographic flow (TIMI flow and MBG). FMD ≤ 6% could predict TIMI I flow.

Relationship Between Systemic Inflammation Index and No-Reflow Phenomenon in Patients With ST-Segment Elevation Myocardial Infarction.

This study aimed to evaluate the relationship between no-reflow phenomenon and systemic inflammation index (SII) and to compare the predictive capacity of SII together with the neutrophil-lymphocyte ratio (NLR), and the platelet-lymphocyte ratio (PLR) in patients with ST-elevation myocardial infarction (STEMI). A total of 785 patients were included. The thrombolysis in myocardial infarction (TIMI) flow degree has been used to describe the no-reflow phenomenon. The study population was divided into two groups regarding the presence of no-reflow phenomenon including 110 patients with no-reflow (TIMI frame count 0-2) and 675 patients without no-reflow (TIMI frame count 3). The NLR [6.6 (4.6-11.6) vs 3.2 (2.0-5.3); P < .001], PLR [175 (121.3-220) vs 102.6 (76.1-150.1); P < .001] and SII [1921(1225-2906) vs 738.5 (450.5-1293); P < .001] were significantly higher in the no-reflow group. High NLR (OR: 1.078, 95%CI: 1.027-1.397; P = .021), PLR (OR: 1.009, 95%CI: 1.003-1.021; P = .041) and SII (OR: 1.216, 95%CI: 1.106-1.942; P = .004) were found to be independently associated with no-reflow phenomenon. The comparison of the receiver-operating characteristic curves showed that area under the curve of SII was greater than that of NLR (.789 vs .766, P = .007) and PLR (.789 vs .759, P = .048). SII levels may predict no-reflow phenomenon better than NLR and PLR.

A Nomogram model for predicting the occurrence of no-reflow phenomenon after percutaneous coronary intervention using the lncRNA TUG1/miR-30e/NPPB biomarkers

BackgroundStudies have shown that percutaneous coronary intervention (PCI) is considered as the essential therapeutic strategy for the patients with ST-segment elevation myocardial infarction (STEMI). However; no-reflow could still occur in a few patients after PCI. Studies have reported that biomarkers related to no-reflow pathogenetic components could play a prognostic role in the prediction phenomenon. Hence, this study explored the establishment of nomogram model for predicting the occurrence of no-reflow phenomenon after PCI using the lncRNA TUG1/miR-30e/NPPB biomarkers in patients with STEMI after PCI.MethodsIn this observational study, a total of 76 STEMI patients who underwent emergency PCI between January 2018 and December 2021were included. The patients after PCI, were divided into reflow (n=44) and no-reflow groups (n=32). The demographic, environmental and clinical risk factors were assessed and analysed between the groups. Quantitative RT-PCR was used to detect TUG1, miR-30e, and NPPB messenger RNA (mRNA) expression levels in the plasma of patients after PCI. Bioinformatic methods were used to predict the interaction of the plasma TUG1/miR-30e/NPPB axis. The risk factors in the no-reflow group were screened using a logistic-regression analysis, and a nomogram prediction model was constructed and validated. Subsequently, a gene set enrichment analysis revealed the function of lncRNA TUG1.ResultsPlasma lncRNA TUG1 and NPPB were more highly expressed and miR-30e was more lowly expressed in the no-reflow group than the normal-reflow group (P<0.001). A negative correlation was observed between lncRNA TUG1 and miR-30e, and between miR-30e and NPPB. However, a positive correlation was observed between lncRNA TUG1 and NPPB mRNA. The bioinformatics analysis predicted multiple binding sites on the lncRNA TUG1 and miR-30e. LncRNA TUG1 [odds ratio (OR): 0.163, 95% confidence interval (CI): 0.021–0.944] and hs-CRP (OR: 2.151, 95% CI: 1.536–3.974) found to be as independent predictors. The C-index of this prediction model was 0.982 (95% CI: 0.956–1.000).ConclusionsTUG1 could function as an effective biomarker for no-reflow among patients with STEMI after PCT and the proposed nomogram may provide information for individualized treatment in patients with STEMI.

MELD-XI score predict no-reflow phenomenon and short-term mortality in patient with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

IntroductionNo-reflow phenomenon (NRP) is one of the complications that mostly occur during percutaneous coronary intervention (PCI). In this study, we comprehensively examined the relationship between the model for end-stage liver disease-XI (MELD-XI) score and NRP. Moreover, we discussed whether the MELD-XI score could be considered as an accurate risk assessment score of patients with ST-segment elevation myocardial infarction (STEMI) who are candidates for PCI.MethodsThis retrospective study involved 693 patients with acute STEMI and who underwent an emergency PCI. They were divided into a normal reflow group or a no-reflow group on the basis of the flow rate of post-interventional thrombolysis in myocardial infarction. Univariate, multivariate logistic regression, and Cox regression analyses were performed to identify the independent predictors of NRP in both groups. Receiver operator characteristic (ROC) curves and Kaplan–Meier curves were plotted to estimate the predictive values of the MELD-XI score.ResultsMELD-XI score was found to be an independent indicator of NRP (odds ratio: 1.247, 95% CI: 1.144–1.360, P < 0.001). Multivariate Cox regression analysis also revealed that the MELD-XI score is an independent prognostic factor for 30-day all-cause mortality (hazard ratio: 1.155, 95% CI: 1.077–1.239, P < 0.001). Moreover, according to the ROC curves, the cutoff value of the MELD-XI score to predict NRP was 9.47 (area under ROC curve: 0.739, P < 0.001). The Kaplan–Meier curves for 30-day all-cause mortality revealed lower survival rate in the group with a MELD-XI score of > 9.78 (P < 0.001).ConclusionThe MELD-XI score can be used to predict NRP and the 30-day prognosis in patients with STEMI who are candidates for primary PCI. It could be adopted as an inexpensive and a readily available tool for risk stratification.