Key result
In patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention, the incidence of no-reflow was 13.2%, with older age, longer door-to-balloon time, and higher admission glucose, neutrophil/lymphocyte ratio, and mean platelet volume identified as significant predictors.
Observational (n=120)
Yes
Elevated admission plasma glucose, neutrophil-to-lymphocyte ratio, mean platelet volume, and prolonged door-to-balloon time are strong predictors of no-reflow and in-hospital MACE in STEMI patients undergoing primary PCI.
May inform no-reflow risk stratification in STEMI; hypothesis-generating and requires prospective validation before practice change.
The term no-reflow was first used by Majno and colleagues in the setting of cerebral ischemia in 1967. This phenomenon was initially described by Krug et al. during induced myocardial infarction in the canine model in1966 and again by Kloner et al. in1974 in which it occurred for 90 min after temporary epicardial coronary artery occlusion. Myocardial tracers, such as carbon black or thioflavin S were injected to document uniform flow distribution across the myocardial tissue after 40 min of occlusion. After 90 min, persistent subendocardial perfusion defects were seen with no-reflow. Objectives: Detection, prevention, and treatment of no-refloware likely to have an important impact on the outcome of PPCI. Here we propose possible personalized forms of prevention and treatment, on the basis of the notion that no-reflow is a dynamic process characterized by multiple pathogenetic components. Methods: We analyzed a total of 120 consecutive patients with STEMI and treated with PPCI between 1st of November 2016 to July 2017 at our institution. The patients are divided into two groups according to the final TIMI flow after the primary PCI, and the incidence of in hospital MACE as follows: Group A: had a normal flow after the PPCI and did not have in hospital MACE; Group B: had either no reflow after the PPCI or experienced in hospital MACE. Results: The incidence of no reflow was 13.2%, and in hospital MACE was 5%, with cardiac death as the predominant form of in hospital MACE. The group with no reflow or in hospital MACE showed significantly older age, longer door to balloon time, higher levels of admission RPG, N/L ratio, and MPV. Compared to the literature, Egyptian patients had more diabetes mellitus, more dyslipidaemia, longer door to balloon time. Conclusions: Older patient age, longer door to balloon time, admission hyperglycemia, higher admission N/L ratio, MPV, longer reperfusion time, elevated level of high sensitive CRP on admission, and markedly elevated levels of CKMB, large thrombus burden LTB, are useful predictive factors for the occurrence of no reflow post PPCI, and/or in hospital MACE.
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AA et al. (2017) conducted an observational in ST Elevation Myocardial Infarction (n=120). Primary percutaneous coronary intervention (PPCI) vs. Normal flow without in-hospital MACE was evaluated on Incidence of no reflow. In patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention, the incidence of no-reflow was 13.2%, with older age, longer door-to-balloon time, and higher admission glucose, neutrophil/lymphocyte ratio, and mean platelet volume identified as significant predictors.
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