Volume 3, Issue 2, June 2019, Page: 22-26
Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention
Khaled Mohamed Said Othman, Cardiology Department, Ain Shams University, Cairo, Egypt
Hesham Samir Abdelaziz AbdelKawy Aggour, Cardiology Department, Ain Shams University, Cairo, Egypt
Samir Saleh Wafa, Cardiology Department, Ain Shams University, Cairo, Egypt
Mohamed El Sayed Zahran, Cardiology Department, Ain Shams University, Cairo, Egypt
Received: Mar. 30, 2019;       Accepted: May 7, 2019;       Published: Jun. 11, 2019
DOI: 10.11648/j.ccr.20190302.11      View  17      Downloads  8
Abstract
Background Primary Percutaneous coronary intervention (PPCI) is an established mainstay in treatment of patients presenting with acute ST elevation myocardial infarction (STEMI). However, successful revascularization of the culprit coronary vessel does not always mean ideal myocardial reperfusion in a portion of patients, mainly because of the no-reflow phenomenon. Myocardial no-reflow is associated with worse contractile dysfunction and higher incidence of complications and is an independent predictor of death and myocardial infarction after PPCI. Objective: To study the relationship between admissions CRP, Albumin, CRP/Albumin ratio, Monocyte, HDL, and Monocyte/HDL ratio, in patients presenting with acute STEMI and angiographic no-reflow after PPCI. Material and Methods: From October 2018 to February 2019, of the 1500 patients who presented with STEMI for PPCI to any of the Ain Shams University Hospitals’ cath labs, we enrolled 150 consecutive patients who had post revascularization angiographic no-reflow. They were allocated to group A. we allocated 150 age, gender, and baseline characteristics matched STEMI patients who had TIMI III flow post revascularization to group B. this was set as the control group. Results: The study population was divided into 2 groups: no-reflow “A” (n = 150) and reflow “B” (n = 150) groups. CRP and Monocytes were significantly higher in the no-reflow group; Albumin and HDL were significantly lower in the no-reflow group. The novel indices, CRP/Albumin ratio (CAR) and Monocytes/HDL ratio (MHR) were both significantly higher in the no-reflow group (p value = 0.000) for both. The tow indices were found to be independent predictors of no-reflow development. Conclusion: Our results suggested that CAR and MHR on admission before PPCI though cheap, and easily measurable laboratory tools, have a significant predictive value with an odds ratio of 0.182 with a p value = 0.000 and 0.321 with a p value = 0.002 respectively. They could help to risk stratify STEMI patients who might suffer from no-reflow phenomenon after PPCI.
Keywords
No-reflow, CRP/Albumin Ratio, Monocytes/HDL Ratio
To cite this article
Khaled Mohamed Said Othman, Hesham Samir Abdelaziz AbdelKawy Aggour, Samir Saleh Wafa, Mohamed El Sayed Zahran, Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention, Cardiology and Cardiovascular Research. Vol. 3, No. 2, 2019, pp. 22-26. doi: 10.11648/j.ccr.20190302.11
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Grines CL, Browne KF, Marco J, et al., (1993): A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. The primary angioplasty in myocardial infarction study group. N Engl J Med; 328: 673–679.
[2]
Michaels AD, Gibson CM, Barron HV. (2000): Microvascular dysfunction in acute myocardial infarction: focus on the roles of platelet and inflammatory media- tors in the no-reflow phenomenon. Am J Cardiol; 85: 50b–60b.
[3]
Kloner RA, Ganote CE, Jennings RB. (1974): The “no-reflow” phenomenon after temporary coronary occlusion in the dog. J Clin Invest; 54:1496–508.
[4]
Thiele H, Schindler K, Friedenberger J, et al., (2008): Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the randomized Leipzig immediate percutaneous coronary intervention abciximab IV versus IC in ST-elevation myocardial infarction trial. Circulation; 118 (1): p. 49-57.
[5]
Lim SY, Bae EH, Jeong MH, et al., (2004): Effect of combined intracoronary adenosine and nicorandil on no-reflow phenomenon during percutaneous coronary intervention. Circulation, 2004. 68 (10): p. 928-932.
[6]
Wilson RF, Laxson DD, Lesser, et al., (1989): Intense microvascular constriction after angioplasty of acute thrombotic coronary arterial lesions. Lancet; 1 (8642): p. 807-11.
[7]
Amit KS, Harsh VS, Arun R, et al., (2015): C-reactive protein, inflammation and coronary heart disease, The Egyptian Heart Journal; 67, 89-97
[8]
Mohammad M, and Omid F. (2013): Components of the Complete Blood Count as Risk Predictors for Coronary Heart Disease In-Depth Review and Update. Tex Heart Inst J; 40 (1): 17–29.
[9]
Ibanez B, James S, Agewall S, et al., (2018): 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J; 39: 119–177.
[10]
The TIMI Study Group. (1984): The Thrombolysis in Myocardial Infarction (TIMI) trial: phase I findings. N Engl J Med; 33: 523-530
[11]
Morishima I, Sone T, Okumura K, et al., (2000): Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol; 36: 1202–1209.
[12]
Tarantini G, Cacciavillani L, Corbetti F, et al., (2005): Duration of ischemia is a major determinant of transmurality and severe microvascular obstruction after primary angioplasty: a study performed with contrast-enhanced magnetic resonance. J Am Coll Cardiol; 46: 1229–1235.
[13]
Hassan AKM, Mohamed HS, Mohamed AM, et al., (2018): Predictors of no-reflow in patients undergoing primary percutaneous coronary intervention. Thrombus aspiration was protective. Egyptian heart journal, Dec; 70 (4): 421–426.
[14]
Mazhar J, Mashicharan M, Farshid A. (2016): Predictors and outcome of no-reflow post primary percutaneous coronary intervention for ST elevation myocardial infarction” Int J carotid Heart Vasc; 10:8-12.
[15]
Ito H, Maruyama A, Iwakura K, et al., (1996): Clinical implications of the 'no reflow' phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation; 93 (2): p. 223-8.
[16]
Resnic FS, Wainstein M, Lee MK, et al., (2003): No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J; 145 (1): p. 42-6.
[17]
Celik T, Balta S, Ozturk C, et al., (2016): Predictors of No-Reflow Phenomenon in Young Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology; 67 (7):683-9.
[18]
Jomaa W, Jnifene Z, Chamtouri I, et al., (2019): Predictors of No-Reflow Phenomenon in Tunisian Patients Undergoing Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction. JACC: Volume 12, Issue 4 Supplement, February.
[19]
Balta S, Celik T, Ozturk C, et al., (2016): The relation between monocyte to HDL ratio and no-reflow phenomenon in the patients with acute ST-segment elevation myocardial infarction” Am J Emerg Med. Aug; 34 (8):1542-7.
[20]
Karabağ Y, Çağdaş M, Rencuzogullari I, et al., (2018): Usefulness of The C‐Reactive Protein/Albumin Ratio for Predicting No‐Reflow in ST‐elevation myocardial infarction treated with primary percutaneous coronary intervention. Eur J Clin Invest; 48: e12928.
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