Platelet/ lymphocyte ratio for prediction of no reflow phenomenon in ST elevation myocardial infarction managed with primary percutanous coronary intervention

Background: Coronary no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) is associated with a poor clinical outcome. Although its pathophysiology is not fully understood, a deregulated systemic inflammatory response plays an important role. We aimed to explore the relationship between platelet ratio (PLR) and no-reflow in patients with acute STEMI who were treated with primary percutaneous coronary intervention (PPCI). Methods: A total of 200 patients with STEMI undergoing primary PCI were included in the study. Transthoracic echocardiographic examination was performed to assess left ventricular (LV) ejection fraction and wall motion score index. Blood samples were assayed for platelet and lymphocyte count before primary PCI. No-reflow was defined as coronary blood flow TIMI grade ≤ II. Results: No-reflow was observed in 58 (29%) of STEMI patients following PPCI. PLR was significantly higher in hypertensive patients compared to normotensive patients (144.7 ± 91.6 vs. 109.1 ± 47.1, respectively, P < 0.001) and in the no-reflow group compared to the normal reflow group (214 ± 93 vs. 101.6 ± 51.3, respectively, P < 0.0001). Logistic regression analysis revealed that PLR (β: 0.485, 95% CI: -0.006 - 0.001, P < 0.002) and LV ejection fraction (β: 0.272, 95% CI: 0.009 - 0.034, P < 0.001) were independent predictors of no-reflow after primary PCI. Conclusion: Pre-procedural increase in PLR is predictive of the no-reflow phenomenon following primary PCI in STEMI patients. Relevance for patients: No reflow phenomenon is an unfavorable complication following primary PCI in patients with acute STEMI. High pre-procedural PLR is an independent predictor of reperfusion failure and helps to identify patients who require prophylactic treatment.