No-reflow Phenomenon In Patients Research Articles

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.

Frequency of No-Reflow Phenomenon in Patients Treated with Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Background: The no-reflow phenomenon is a critical complication following percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI), which can significantly affect morbidity and mortality. Despite advancements in interventional cardiology, no-reflow remains a challenge, with various factors contributing to its occurrence. Objective: This study aims to identify independent risk factors for the no-reflow phenomenon in STEMI patients undergoing direct PCI and to develop a practical scoring system for predicting the likelihood of its occurrence. Methods: In a retrospective cohort analysis, 1,345 patients who underwent direct PCI at a single center were evaluated. Baseline characteristics, clinical manifestations, and angiographic findings were meticulously recorded. Multivariate logistic regression was employed to ascertain independent predictors for no-reflow. The derived scoring system was based on statistically significant variables, including age, collateral circulation, thrombus burden, lesion diameter, and ACEI/ARB therapy. Results: The mean age of the development cohort (n=1011) was 61.2±11.2 years, with the validation cohort (n=334) averaging 62.1±10.8 years. No-reflow was present in 80.1% of the development group with TIMI blood flow grade 1. Independent predictors of no-reflow included age ≥55 years (OR 2.100, p=0.001), collateral circulation &lt;grade 2 (OR 2.907, p=0.002), thrombus burden ≥4 points (OR 1.920, p&lt;0.001), and lack of ACEI/ARB therapy (OR 1.678, p=0.017). The scoring system demonstrated a sensitivity of 42.0% and a specificity of 78.4%, with PPV and NPV of 45.8% and 78.5%, respectively. Conclusion: The study identified several key predictors for no-reflow and established a scoring system that may aid clinicians in the early identification of patients at risk for no-reflow post-PCI. This scoring system, given its simplicity and reliance on readily available clinical data, has the potential to be incorporated into routine clinical practice, subject to validation in future prospective studies.

Predictors of No-Reflow Phenomenon in Primary Percutaneous Coronary Intervention among Patients with Acute Myocardial Infarction

Background: The no-reflow phenomenon, characterized by the failure to restore myocardial blood flow after reopening an occluded artery in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI), has significant implications for patient prognosis. Understanding the predictors of no-reflow is crucial for improving clinical outcomes in this high-risk population. Objective: This study aims to identify the predictors of the no-reflow phenomenon in patients with AMI undergoing PCI and to assess their impact on the efficacy of the intervention. Methods: Conducted at Lady Reading Hospital's Cardiology Department, this descriptive study retrospectively analyzed 120 AMI patients treated with PCI from May 2023 to November 2023. Ethical approval was obtained, and the study conformed to the Declaration of Helsinki. The diagnosis of AMI was based on clinical symptoms and electrocardiographic findings. Experienced cardiologists performed PCI, and no-reflow was defined using Thrombolysis in Myocardial Infarction (TIMI) flow grades and Myocardial Blush Grade (MBG). Data were analyzed using SPSS Version 25, focusing on demographic variables, clinical presentations, and procedural details to identify predictors of no-reflow. Results: Out of 120 patients, 70.8% were male. The incidence of no-reflow was 22.5%. Significant predictors of no-reflow included systolic blood pressure &lt; 100 mmHg (51.9% in no-reflow vs. 28.0% in normal flow, P=0.02), diabetes (59.3% vs. 34.4%, P=0.02), hypertension (77.8% vs. 31.2%, P=0.0001), and history of cardiovascular disease (11.1% vs. 2.2%, P=0.04). Conclusion: The study identified diabetes, hypertension, low systolic blood pressure, and a history of cardiovascular disease as significant predictors of the no-reflow phenomenon in AMI patients undergoing PCI. These findings highlight the importance of identifying and managing these risk factors to enhance the success of PCI and improve patient outcomes.

The predictive value of laboratory parameters for no-reflow phenomenon in patients with ST-elevation myocardial infarction following primary percutaneous coronary intervention: A meta-analysis.

To date, the predictive role of laboratory indicators for the phenomenon of no flow is unclear. Hence, our objective was to conduct a meta-analysis to investigate the association between laboratory parameters and the risk of the no-reflow phenomenon in patients with ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI). This, in turn, aims to offer valuable insights for early clinical prediction of no-reflow. We searched Pubmed, Embase, and Cochrane Library from the establishment of the database to October 2023. We included case-control or cohort study that patients with STEMI following primary PCI. We excluded repeated publication, research without full text, incomplete information or inability to conduct data extraction and animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data. The pooled results indicated that elevated white blood cell (WBC) count (odds ratio [OR] = 1.061, 95% confidence interval [CI]: 1.013-1.112), neutrophil count (OR = 1.324, 95% CI: 1.128-1.553), platelet (PLT) (OR = 1.002, 95%CI: 1.000-1.005), blood glucose (OR = 1.005, 95%CI: 1.002-1.009), creatinine (OR = 1.290, 95%CI: 1.070-1.555), total cholesterol (TC) (OR = 1.022, 95%CI: 1.012-1.032),d-dimer (OR = 1.002, 95%CI: 1.001-1.004), and fibrinogen (OR = 1.010, 95%CI: 1.005-1.015) were significantly associated with increased risk of no-reflow. However, elevated hemoglobin was significantly associated with decreased risk of no-reflow. In conclusion, our comprehensive analysis highlights the predictive potential of various parameters in assessing the risk of no-reflow among STEMI patients undergoing PCI. Specifically, WBC count, neutrophil count, PLT, blood glucose, hemoglobin, creatinine, TC, d-dimer, and fibrinogen emerged as significant predictors. This refined risk prediction may guide clinical decision-making, allowing for more targeted and effective preventive measures to mitigate the occurrence of no-reflow in this patient population.

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.

The non-HDL-C/HDL-C ratio is a strong and independent predictor of the no-reflow phenomenon in patients with ST-elevation myocardial infarction

Background No-reflow (NR) is the inability to achieve adequate myocardial perfusion despite successful restoration of attegrade blood flow in the infarct-related artery after primary percutaneous coronary intervention. The non-HDL-C/HDL-C ratio has been shown to be superior to conventional lipid markers in predicting most cardiovascular diseases. In this study, we wanted to reveal the predictive value of the NR by comparing the Non-HDL-C/HDL-C ratio with traditional and non-traditional lipid markers in patients who underwent primary percutaneous coronary intervention (pPCI) due to ST-elevation myocardial infarction (STEMI). Methods A total of 1284 consecutive patients who underwent pPCI for STEMI were included in this study. Traditional lipid profiles were detected and non-traditional lipid indices were calculated. Patients were classified as groups with and without NR and compared in terms of lipid profiles. Results No-reflow was seen in 18.8% of the patients. SYNTAX score, maximal stent length, high thrombus burden, atherogenic index of plasma and non-HDL-C/HDL-C ratio were determined as independent predictors for NR (p < 0.05, for all). The non-HDL-C/HDL-C ratio predicts the development of NR in STEMI patients with 71% sensitivity and 67% specificity at the best cut-off value. In ROC curve analysis, the non-HDL-C/HDL-C ratio was superior to traditional and non-traditional lipid markers in predicting NR (p < 0.05, for all). Conclusion The non-HDL-C/HDL-C ratio can be a strong and independent predictor of NR in STEMI patients and and therefore non-HDL-C/HDL-C ratio may be a useful lipid-based biomarker that can be used in clinical practice to improve the accuracy of risk assessment in patients with STEMI.

A New Inflammatory Marker of the No-reflow Phenomenon after Percutaneous Coronary Intervention (PCI) to Saphenous Venous in Patients with Coronary Artery Disease

Background: Although numerous mechanisms regarding the no-reflow phenomenon (NRP) have been mentioned, they have not yet been fully elucidated. The NRP can impact the success rate even in a technically flawless percutaneous coronary intervention (PCI), which can be annoying. Before the procedure, there is no specific parameter or index that can assess a significant factor such as NRP that has a direct impact on the success of the PCI. Objectives: The present study aimed to evaluate the relationship between the systemic immune-inflammation index (SII) and NRP in patients who underwent PCI for saphenous vein graft (SVG). Methods: In this retrospective cohort study, 312 coronary artery bypass grafting (CABG) patients admitted to primary or elective SVG and those who underwent PCI between January 2014 and December 2021 were selected. Routine blood samples were taken from the patients at the time of admission, and SII was calculated as the ratio of the product of the total neutrophil count and the total platelet count to the lymphocyte count. The reperfusion rates after PCI were evaluated according to the thrombolysis in myocardial infarction (TIMI) grade flow and myocardial blush grade (MBG). Following the procedure, those with an angiographic TIMI flow grade of ≤ 2 or TIMI flow grade of 3 and a final MBG of &lt; 2 were considered NRP. Results: The number of 85 patients (27.2%) were diagnosed with NRP. The SII and ST-elevation myocardial infarction were found to be independent predictors for NRP in multivariate logistic regression analysis (P&lt;0.05). The SII predicted NRP with a sensitivity of 86% and a specificity of 80% (AUC: 0.866, 95% CI: 0.823 to 0.910, P&lt;0.001) using a cut-off point of 13.45. Conclusion: The SII is an independent predictor that can be easily calculated from the whole blood test to predict no-reflow development, which is a frustrating complication in patients following the PCI to the saphenous vein. This predictor can enable us to pre-evaluate the non-operational reasons affecting the procedure's success.

Incidence, Predictors, and Prognosis of Coronary Slow-Flow and No-Reflow Phenomenon in Patients undergoing Elective PCI

Incidence, Predictors, and Prognosis of Coronary Slow-Flow and No-Reflow Phenomenon in Patients undergoing Elective PCI

A retrospective study: Association of C-reactive protein and uric acid to albumin ratio with the no-reflow phenomenon in patients with ST elevation myocardial infarction

BackgroundThe no-reflow phenomenon increases mortality and morbidity in patients with ST-segment elevation myocardial infarction (STEMI). Inflammation, endothelial dysfunction, and oxidative stress play important role in its pathophysiology. We aim to evaluate the relationship between the no-reflow phenomenon and C-reactive protein (CRP) and uric acid (UA) to albumin ratio (CUAR), which is a new marker indicating all these pathophysiological mechanisms. Methods and resultsStudy population were divided into two groups as no-reflow and reflow; according to the post-procedural thrombolysis in myocardial infarction flows and myocardial blush grade. A1:4 propensity score matching was performed.CUAR was calculated by using the following formula: log10 (CRP x UA /Albumin). CUAR levels were significantly higher in patients with no-reflow than in those with reflow (P < 0.001). CUAR levels above 1.28 predicted no-reflow with higher sensitivity of 74% and specificity of 71% than all including CRP, UA and albumin (AUC = 0.80 [95%CI: 0.76–0.83], P < 0.001). In multivariate logistic regression analysis, CUAR levels above 1.28 (OR: 4.43 [3.04–6.46], 95% CI; P < 0.001) wereindependently associated with no-reflow phenomenon. ConclusionOur results showed that CUAR could be a basic and available marker to predict no-reflow in patients with STEMI who underwent primary percutaneous coronary intervention.

Investigation of the relationship between modified Glasgow prognostic score and no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Objectives: No-reflow phenomenon (NRP) is a complication associated with poor clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The modified Glasgow prognostic score (mGPS) is a novel immune-inflammatory index, derived from C-reactive protein (CRP) and serum albumin levels and has been shown to be associated with prognosis in heart disease. In this study we aimed to investigated the relationship between mGPS and NRP in patients undergoing pPCI for STEMI. Methods: A total of 379 patients (aged 59 ± 9.9 years; 54.9% male) were enrollled. The patients were divided into 2 groups:no-reflow (n = 72) and reflow (n = 307). No-reflow was defined as thrombolysis in myocardial infarction (TIMI) ≤ 2 flow. The mGPS of all patients was calculated from blood samples at admission. Logistic regression analysis was performed to determine the independent predictive factors for NRP. Results: Mean age, pain to balloon duration, troponin T, white blood cell (WBC), Syntax score, neutrophil to lymphocyte ratio (NLR), glucose level, C-reactive protein level (CRP), diabetic and female patient ratio were higher, while left ventricular ejection fraction, ST segment resolution ratio at 60 min, and serum albumin level were lower in the NRP group.Logistic regression analysis showed that WBC count [Hazard ratio (HR): 0.816, 95% confidence interval (CI): 0.728-0.914, p &amp;lt; 0.001], NLR (HR: 0.482, CI: 0.355-0.654, p &amp;lt; 0.001), pain-to-balloon time (HR: 0.976, CI:0.960-0.991, p = 0.002) and mGPS (HR: 3.213, CI: 1.643- 6.283, p = 0.001) were independent predictive factors for NRP. Conclusions: Modified GPS is an independent predictive factor for NRP in patients undergoing pPCI for STEMI.

Neutrophil-to-Lymphocyte Ratio and Mean Platelet Volume in Predicting Coronary No-Reflow in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract Background This study was designed to investigate the role of neutrophil-to- lymphocyte ratio and mean platelet volume in predicting coronary no-reflow in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Objectives knows the role of neutrophil-to-lymphocyte ratio and mean platelet volume in predicting coronary no-reflow in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Patients and Methods The patients were divided into 2 groups according to TIMI flow grades after primary PCI. 50 patients with TIMI flow grade 3 formed (reflow group) and 50 patients with TIMI flow grades 0-2 formed (no reflow group). Results Cases which manipulated with post stent dilatation in no reflow group were significantly higher than in the reflow group (P = 0.028). EF by M mode was significantly lower in the no reflow group cases compared to those of reflow group (P = 0.040). Absolute lymphocytes were significantly higher in the no reflow group cases compared to those of reflow group (P = 0.001). Neutrophils to lymphocytes ratio were significantly higher in the no reflow group cases compared to those of reflow group (P = 0.011). MPV was significantly higher in the no reflow group cases compared to those of reflow group (P = 0.001). Hb level was significantly higher in the no reflow group cases compared to those of reflow group (P = 0.005). Mean platelet volume and Neutrophil to lymphocyte ratio are considered a promising positive predictors of no-reflow phenomenon after primary PCI. Conclusion Mean platelet volume is considered as a promising positive predictor of no-reflow phenomenon after primary PCI. Post stent dilatation and EF by M mode are new independent factors for predicting no-reflow phenomenon in patients 1 undergoing PPCI. Neutrophils to lymphocytes ratio has a role in predicting no reflow phenomenon in patients undergoing PPCI.

Prognostic value and clinical usefulness of PIANO score in patients undergoing primary percutaneous coronary intervention

BackgroundIn our previous study, the PIANO score was constructed to predict the occurrence of no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention (PCI). In the current analysis, we sought to evaluate the prognostic value and clinical usefulness of the PIANO score in this population. MethodsPatients with acute myocardial infarction (AMI) undergoing primary PCI were consecutively enrolled and followed up in this register. The endpoint of interest was all-cause mortality at 2 years after the procedure. The clinical benefits of thrombus aspiration (TA) during primary PCI in certain subgroups were also evaluated as exploratory analyses. ResultsA total of 2100 patients were identified, and 54.3% had high (≥8) PIANO score. After 2-year follow-up, patients with high PIANO score had higher risk of all-cause mortality after adjustment for propensity score (6.7% vs. 3.1%, adjusted hazard ratio = 2.11 [1.21–3.68], p = 0.008), especially in the first month (adjusted hazard ratio = 2.33 [1.17–4.65], p = 0.017). Restricted cubic spline analysis indicated the linear association between the PIANO score and 2-year all-cause mortality (nonlinear p = 0.556). Further analysis demonstrated that TA did not reduce all-cause mortality in the overall patients, as well as in those with visible thrombus, high thrombus burden, or occlusive lesions. However, the PIANO score defined “high-risk” (PIANO score ≥ 8) patients could benefit from it. ConclusionsThe PIANO score had potential prognostic value in patients with AMI undergoing primary PCI. It might also be helpful for identifying patients who would benefit from TA. These observations require further confirmation in future studies.

Comparison of the efficacy of excimer laser coronary angioplasty for ST-segment elevation myocardial infarction with onset-to-balloon time.

Excimer laser coronary angioplasty (ELCA) vaporizes plaques and thrombi, provides better microcirculation, and reduces peripheral embolism when treating acute coronary syndrome. Studies on the efficacy of ELCA for long onset-to-balloon time ST-segment elevation myocardial infarction (STEMI) are limited. Thus, we aimed to examine the efficacy of ELCA for STEMI using the onset-to-balloon time (OBT). A total of 319 patients with STEMI who underwent percutaneous coronary intervention from 2009 to 2012 and from 2015 to 2019 were enrolled. Patients who underwent PCI in 2009-2012 were considered the conventional group, and those treated with ELCA in 2015-2019 were considered the ELCA group. Patients were stratified by OBT. The endpoints were the final thrombolysis in myocardial infarction (TIMI) grade, myocardial blush grade (MBG), and slow-flow or no-reflow phenomenon during the procedure. The ELCA group had 167 patients, and the conventional group had 123. There was no significant difference in achieving final TIMI 3 between the groups. The acquisition rate of final MBG 3 was significantly higher in the ELCA than in the conventional group (79.6% vs. 65.9%; P = 0.01). There was a significant difference between the groups with OBT 12-72h (82.1% vs. 56.0%; P = 0.031). The slow- or no-reflow incidence during the procedure was significantly lower in the ELCA than in the conventional group with OBT 12-72h (17.8% vs. 52.2%; P = 0.019). ELCA improves the MBG and reduces intraoperative slow- or no-reflow phenomenon in patients with STEMI, 12-72h after onset. ELCA will be useful in preventing peripheral embolism in patients with long onset-to-balloon time STEMI.

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.

Assessment of systemic immune-inflammation index as an independent surrogate biomarker of no-reflow phenomenon in acute coronary syndrome patients with coronary artery bypass grafting undergoing percutaneous coronary intervention of saphenous vein graft.

Numerous mechanisms have been proposed for the no-reflow phenomenon (NRP) in the literature including leukocyte intravascular plugging, microembolisms, and extrinsic coagulation pathway activation. Some of the more recent studies suggested a relationship between NRP and systemic immune-inflammation index (SII) in different contexts. To this end, the objective of this study was to investigate the relationship between NRP and SII in acute coronary syndrome (ACS) patients with coronary artery bypass grafting (CABG) who underwent percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) of saphenous vein graft (SVG). The sample of this retrospective study consisted of 124 ACS patients with CABG who underwent PTCA/PCI of SVG. The incidence of NRP in the study group was 30.6% (n=38). The results of the multivariate logistic regression analysis indicated that ST-elevation myocardial infarction (STEMI) and SII were independent predictors for NRP (p<0.05). The receiver operating characteristic (ROC) curve analysis revealed that the optimal cut-off value of SII in predicting the development of NRP in patients undergoing PTCA/PCI of SVG and the sensitivity and specificity values thereof are 975, 74%, and 80%, respectively [Area under the curve (AUC): 0.84, 95% confidence interval (CI): 0.76-0.91, p-value <0.001]. The study findings indicated that SII, which can be easily calculated from a single complete blood count test, is an independent predictor of the development of NRP in ACS patients undergoing PTCA/PCI of the SVG.

Growth Differentiation Factor 15 as a Predictor of the No-Reflow Phenomenon in Patients with ST-Segment Elevation Myocardial Infarction.

Growth differentiation factor 15 (GDF-15) and the no-reflow phenomenon are predictors of mortality after ST-segment elevation myocardial infarction (STEMI). We aimed to assess the relation between GDF-15 concentration on admission and the no-reflow phenomenon. The study was conducted prospectively among 80 consecutive STEMI patients who underwent primary PCI. No-reflow was defined as a corrected TIMI frame count > 27 and myocardial blush grade < 3 after PCI. GDF-15 was measured on admission. We assessed long-term (1.3 years) total mortality and the risk factors of no-reflow. The mean age was 65 (SD 12) years. Mortality rates were 2.5% and 7.5% for in-hospital and long-term observations, respectively. No-reflow occurred in 24% of patients. A negative correlation between TIMI flow after PCI and GDF-15 concentration (R = −0.2540, p = 0.023) was found. Receiver operating characteristic (ROC) analysis revealed GDF-15 as a predictor of no-reflow (AUC-0.698, 95%CI-0.552−0.843, p < 0.05). The multivariate logistic regression analysis revealed that the risk factors for no-reflow occurrence were higher age, a concentration of GDF-15 > 1503 pg/mL, lower systolic blood pressure, and higher troponin I concentration on admission. A higher concentration of GDF-15 can be used as an additional marker of ischemia/reoxygenation injury, subsequent no-reflow phenomenon, and worse long-term outcomes in patients with STEMI.

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.

Prevalence and prognostic implications of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention in a university center in a middle-income country

Abstract Background No-reflow (TIMI flow ≤2) during primary PCI for STEMI occurs in 7–25% of cases, indicates poor myocardial tissue perfusion, and is associated with a poor outcome. (1–3) The incidence in our hospital is unknow. Purpose To analyse the prevalence of no-reflow and the 30-day mortality in our hospital. Methods We analysed the database of a teaching hospital and identified 2463 patients who underwent primary PCI from January 2006 to December 2021. No-reflow was defined as post-PCI TIMI flow ≤2, in the absence of post-procedural significant (≥25%) residual stenosis, abrupt vessel closure, dissection, perforation, thrombus of the original target lesion, or epicardial spasm. The outcome measure was 30-day mortality. Results Of total of 2050 patients, no-reflow phenomenon was found in 413 (16.8%) patients, and it was associated with significantly higher 30-day mortality (16.7% vs. 4.29%; p = &amp;lt;0.001). Patients with no-reflow were older (60 [53–69.5] vs. 59 [51–66]; p=0.001), with a higher delay in onset of symptom to emergency department arrival (270 min vs. 247 min; p=0.001) but had similar door to balloon time (75 min vs. 80 min; p=0.434). No-reflow patients also had had fewer previous myocardial infarction (11.6 vs. 18.4; p=0.001), lower systolic blood pressure (128 mm Hg vs. 132 mm Hg; p = &amp;lt;0.001) and a Killip class &amp;gt;1 (37% vs. 26.4%; p = &amp;lt;0.001). No-reflow patients were more likely to have an anterior myocardial infarction (55.4% vs. 47.8; p=0.005), initial TIMI flow 0 (76% vs. 68%; p = &amp;lt;0.001) and TMP 0 (14.1% vs. 4.5%; p = &amp;lt;0.001). Conclusion No-reflow occurred in 16.8% of STEMI patients undergoing primary PCI and was more likely with older age, delayed presentation, anterior myocardial infarction and Killip class &amp;gt;1. No-reflow was associated with a higher mortality at 30-day follow-up. Funding Acknowledgement Type of funding sources: None.

CHA2 DS2 -VASc score, a simple clinical tool for early prediction of no-reflow phenomenon in patients undergoing emergency percutaneous coronary revascularization.

Introduction: Slow flow/no reflow (SF/NR) phenomenon during emergency percutaneous revascularization is a feared complication associated with increased risk of adverse outcomes. CHA2 DS2 -VASc score has been proposed for the risk stratification but a very limited evidences are available regarding the accuracy of this system. Therefore, we conducted this study to assess the predictive value of CHA2 DS2 -VASc score for predicting SF/NR phenomenon during primary percutaneous coronary intervention (PCI). Methods: This analytical cross-sectional study included 596 consecutive patients undergoing PCI for STEMI at a tertiary care cardiac center of Karachi, Pakistan. Baseline -VASc sore was calculated and development of SF/NR phenomenon during primary PCI was recorded. Predictive value of the score was assessed through area under the curve (AUC) of receiver operating characteristic curve analysis and sensitivity and specificity were computed. Logistic regression analysis was performed to assess the predictive strength of the score. Results: A total of 596 patients were included, mean age was 56.28±11.44 years, and 75.7%(451) were male. The slow/no reflow phenomenon during the procedure was observed in 36.6%(218) of the patients. CHA2 DS2 -VASc≥2 was observed in 50.2%(299) of the patients. The CHA2 DS2 -VASc score was significantly higher in SF/NR patients, 2.06±1.25 vs. 1.37±1.33; P<0.001. The AUC of CHA2 DS2 -VASc score was 0.652 [0.607-0.696], CHA2 DS2 -VASc≥2 had sensitivity and specificity of 65.6% [58.9% to 71.9%] and 58.3% [53.6% to 63.7%] respectively for predicting SF/NR. CHA2 DS2 -VASc≥2 was insignificant on multivariate with odds ratio of 1.48 [0.72 -3.04]; P=0.283. Conclusion: CHA2 DS2 -VASc risk stratification system has moderate discriminating power for the stratification of SF/NR phenomenon during primary PCI.