Novel predictors and adverse long-term outcomes of No-reflow phenomenon in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.
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 <3 (43%). Fibrinogen to albumin ratio (FAR), high sensitive C-reactive protein to albumin ratio (CAR), and atherogenic index of plasma (AIP) were calculated. Long term mortality and morbidity during 6 months follow up were recorded. These data were compared among both groups.


RESULTS
In multivariate regression analysis, old age (OR = 1.115, 95% CI: 1.032-1.205, P = 0.006), higher troponin level >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 < 0.001) could be considered as predictors for the development of no-reflow. Interestingly, CAR >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.
['Refaat|Hesham|H|', 'Tantawy|Ayman|A|', 'Gamal|Amr S|AS|', 'Radwan|Hanan|H|']
D000368:Aged D017023:Coronary Angiography D003326:Coronary Circulation D003430:Cross-Sectional Studies D004534:Egypt D005260:Female D005500:Follow-Up Studies D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D054318:No-Reflow Phenomenon D062645:Percutaneous Coronary Intervention D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D000072657:ST Elevation Myocardial Infarction D013997:Time Factors
Novel predictors Outcomes No-reflow Myocardial infarction