What is the clinical evidence from this study?

Study design: Cohort. Population: ST elevation myocardial infarction (STEMI) (n=400). Intervention: Elevated CAR (>0.21), FAR (>11.56), and AIP (>0.52) vs. Lower CAR, FAR, and AIP. Primary outcome: Development of no-reflow (TIMI flow <3) (OR 3.357, 95% CI 2.288-4.927, p=<0.001).

December 29, 2020Open Access

Novel predictors and adverse long-term outcomes of No-reflow phenomenon in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention

Q: What are the key findings of this study?

Elevated CAR >0.21 (OR 3.357; 95% CI 2.288-4.927), FAR >11.56, and AIP >0.52 independently predicted the no-reflow phenomenon in STEMI patients undergoing primary PCI.

HRHesham RefaatUniversità Cattolica del Sacro Cuore ATAyman TantawyZagazig University AGAmr GamalUniversity of Liverpool

Key Result

Elevated CAR >0.21 (OR 3.357; 95% CI 2.288-4.927), FAR >11.56, and AIP >0.52 independently predicted the no-reflow phenomenon in STEMI patients undergoing primary PCI.

Study Design

Type

Cohort (n=400)

Structured PICO

Do novel biomarkers (CAR, FAR, and AIP) predict the no-reflow phenomenon and subsequent adverse outcomes in STEMI patients undergoing primary PCI?

Population

400 STEMI patients undergoing primary PCI, followed for 6 months to evaluate predictors and outcomes of the no-reflow phenomenon.

Exposure

High sensitive C-reactive protein to albumin ratio (CAR), fibrinogen to albumin ratio (FAR), and atherogenic index of plasma (AIP)

Comparator

Patients with normal flow (TIMI flow 3)

Outcome

Development of no-reflow phenomenon (TIMI flow <3) and long-term mortality and morbidity (heart failure) during 6 months follow-upsurrogate

Novel biomarker ratios including CAR, FAR, and AIP are strong independent predictors of the no-reflow phenomenon in STEMI patients undergoing primary PCI, which correlates with increased 6-month mortality and heart failure.

Main Result

Odds Ratio: 3.357 (95% CI 2.288–4.927)

p-value: p=<0.001

Abstract

OBJECTIVES: The no-reflow phenomenon occurs in 25% of patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and may be associated with adverse outcomes. The aim of our study was to detect novel predictors of no-reflow phenomenon and the resulting adverse long term outcomes. METHODS: We enrolled 400 STEMI patients undergoing primary PCI; 228 patients had TIMI flow 3 after PCI (57%) and the remaining 172 patients had TIMI flow 5.6 ng/mL (OR = 1.040, 95% CI: 1.001-1.080, P = 0.04), diabetes mellitus (OR = 4.401, 95% CI: 1.081-17.923, P = 0.04) and heavy thrombus burden (OR = 16.915, 95% CI: 5.055-56.602, P 0.21, FAR >11.56, and AIP >0.52 could be considered as novel powerful independent predictors (OR = 3.357, 95% CI: 2.288-4.927, P < 0.001, OR = 4.187, 95% CI: 2.761-6.349, P < 0.001, OR = 16.794, 95% CI: 1.018-277.01, P = 0.04, respectively). Higher long term mortality (P < 0.001) and heart failure (P < 0.001) was also strongly related to incidence of no-reflow. CONCLUSION: No-reflow could be attributed to novel predictors as CAR, FAR, and AIP. This phenomenon was associated with long term adverse events as higher mortality and pump failure.

Ask AI

Helpful

Bookmark

View Full Paper