Risk Factors for No-Reflow in Patients with ST-Elevation Myocardial Infarction Who Underwent Percutaneous Coronary Intervention: A Case-Control Study

Abstract

Background and Objectives. The no-reflow phenomenon is a poor prognosis for patients with ST-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI). The purpose of this study was to identify the risk factors for no-reflow in patients with STEMI who underwent PCI. Methods. This case-control study retrospectively reviewed the medical data of patients treated with primary percutaneous coronary intervention within 12 h after STEMI onset between January 2010 and January 2013 at the Department of Cardiology of the Beijing Anzhen Hospital. Results. A total of 902 patients were included in the analysis. The basic characteristics between the reflow and no-reflow groups were similar, except for time-to-hospital admission, heart rate, plasma glucose, high-sensitivity C-reactive protein (hsCRP)/prealbumin (PAB), neutrophil count, intraaortic balloon pump, and aspiration thrombectomy. The multivariable analysis showed that hsCRP/PAB (OR = 1.003, 95% CI: 1.000–1.006, P = 0.022 ), neutrophil count (OR = 1.085, 95% CI: 1.028–1.146, P = 0.003 ), plasma glucose levels (OR = 1.086, 95% CI: 1.036–1.138, P = 0.001 ), diabetes mellitus (OR = 0.596, 95% CI: 0.371–0.958, P = 0.033 ), Killip classification >1 (OR = 2.002, 95% CI: 1.273–3.148, P = 0.003 ), intraoperative intraaortic balloon pump (IABP) use (OR = 3.257, 95% CI: 1.954–5.428, P = 0.001 ), and aspiration thrombectomy (OR = 3.412, 95% CI: 2.259–5.152, P = 0.001 ) were independently associated with no-reflow. Conclusion. hsCRP/PAB, neutrophil count, plasma glucose levels, diabetes mellitus, Killip classification, intraoperative IABP use, and aspiration thrombectomy were independent risk factors for no-reflow in patients with STEMI.

Utility of electrocardiogram to predict the occurrence of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention (PPCI): a systematic review and meta-analysis

“…The presence of certain comorbidities, such as hyperglycemia, hypertension, hypercholesterolemia, renal insufficiency, plaque composition, and high thrombus burden, have been linked to an increased risk of no-reflow phenomena in patients. This association may be attributed to underlying vascular disease, inflammation, and elevated oxidative stress that often accompany these conditions (29). Imaging techniques like contrast-enhanced echocardiography, cardiac MRI, and angiography can be helpful in predicting the onset of the no-reflow phenomenon by providing valuable insights into the severity and extent of myocardial damage and impaired blood flow.…”

Predictive effect of triglyceride-glucose index on No-Reflow Phenomenon in patients with type 2 diabetes mellitus and acute myocardial infarction Undergoing Primary Percutaneous Coronary Intervention

“…Insulin can mediate antilipolysis, but insulin resistance in adipose tissue can reduce this effect, leading to a decrease in lipoprotein lipase activity and further induction of hyperlipidemia, it is a major cause of dyslipidemia in T2DM and can aggravate coronary atherosclerosis [24]. Additionally, Hyperglycemia in patients with AMI may further contribute to the phenomenon of no-re ow by increasing leukocyte obstruction in the capillaries, leading to increased levels of intercellular adhesion molecule-1 or p-selectin [25]. Microthrombosis after AMI has been shown to play an important role in the prevention of re ow obstruction.…”

Investigation of the relationship between modified Glasgow prognostic score and no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

“…Aggregation of activated leukocytes in the capillary region may directly disrupt blood flow [20]. In addition, leukocyte aggregation is thought to cause additional vascular injury by leading to edema in the endothelial bed, increased permeability and oxygen radicals [21]. Consistent with these mechanisms, WBC count is usually high in patients with acute myocardial infarction.…”