Predictive Value of High‐Sensitivity CRP Level on the No‐Reflow Phenomenon in STEMI Patients

Background: Increased level of high-sensitivity C-reactive protein (hs-CRP) is associated with no-reflow phenomenon. Therefore, even when timely coronary revascularization is performed through the primary percutaneous coronary intervention (pPCI), the process can induce reperfusion injury. Purpose: We evaluated the influence of hs-CRP level on the no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI). Methods: In this study, we included one hundred and eighty-two consecutive patients with STEMI of onset < 12 h, who underwent pPCI. The levels of creatine kinase (CK), the MB fraction of creatine kinase (CK-MB), troponin I, hs-CRP, and other routine laboratory parameters were measured. Measurement of hs-CRP was done on the day of admission by Cobas assay (particle-enhanced immunoturbidimetric assay) on Cobas c501 (Roche). Thereafter, patients were divided in two groups according to the thrombolysis in myocardial infarction (TIMI) flow grade. Results: From a total of 182 STEMI patients who underwent pPCI, the median value of hs-CRP of the patients with TIMI grade flow 3 (successful reperfusion) was 8.5 (0.4-268) and of the patients with no-reflow phenomenon (unsuccessful reperfusion, TIMI flow grade ≤ 2) was 37.90 (1.8-271.20), p < 0.0001. Receiver operating characteristics (ROC) curve of hs-CRP plots the true positive rate against the false positive rate at different cutoff points, AUC = 0.73 (95% CI, 0.64-0.81), and the cutoff value for the hs-CRP was 18.0 mg/L, p=0.0001. Conclusions: hs-CRP may be associated with no-reflow phenomenon in STEMI patients. The cutoff value for hs-CRP may be used to identify patients at risk for reperfusion injury.