Patients with a history of no-reflow after PCI for STEMI had an 18% lower fibrin clot permeability and up to 45% prolonged fibrinolysis compared to controls (P<0.0001).
Case-Control (n=61)
Is the no-reflow phenomenon after primary PCI for STEMI associated with altered fibrin clot permeability and susceptibility to lysis?
Survivors of STEMI with a history of no-reflow after PCI exhibit more compact fibrin networks that are resistant to lysis, suggesting a persistent prothrombotic phenotype.
p-value: p=<0.0001
OBJECTIVE: We assessed the relationship between fibrin clot properties and the no-reflow phenomenon after primary coronary intervention (PCI). METHODS AND RESULTS: Epicardial blood flow was assessed by TIMI scale and corrected TIMI frame count (cTFC), and perfusion by TIMI Myocardial Perfusion Grade (TMPG) after PCI during ST-segment elevation myocardial infarction (STEMI). Fibrin clot permeability (K(s)) and susceptibility to lysis in assays using exogenous thrombin (t(50%)) and without thrombin (t(TF)) were determined in 30 no-reflow patients (TIMI < or = 2) and in 31 controls (TIMI-3) after uneventful 6 to 14 months from PCI. Patients with TIMI < or = 2 had lower K(s) by 18% (P<0.0001) and prolonged fibrinolysis by 33% for t(50%) (P<0.0001) and by 45% for t(TF) (P<0.0001). cTFC was correlated with K(s) (r=-0.56, P<0.0001), t(50%) (r=0.49, P<0.001), and t(TF) (r=0.54, P<0.001). K(s) increased in a stepwise fashion with TIMI flow (P<0.0001) and TMPG (P<0.0001), whereas both fibrinolysis times decreased with TIMI flow (P<0.0001 for both) and TMPG (P<0.01 for both). Multiple regression models showed that only K(s) and fibrinogen were independent predictors of cTFC (P<0.05 for both), TIMI < or = 2 flow (P<0.05 for both) and TMPG-0/1 (P<0.05 for both). CONCLUSIONS: Survivors of myocardial infarction with a history of the no-reflow after PCI are characterized with more compact fibrin network and its resistance to lysis.
Zalewski et al. (Fri,) conducted a case-control in ST-segment elevation myocardial infarction (STEMI) (n=61). No-reflow phenomenon (TIMI ≤ 2) vs. Normal flow (TIMI-3) was evaluated on Fibrin clot permeability (Ks) and susceptibility to lysis (t50% and tTF) (p=<0.0001). Patients with a history of no-reflow after PCI for STEMI had an 18% lower fibrin clot permeability and up to 45% prolonged fibrinolysis compared to controls (P<0.0001).