Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention

Khaled Mohamed Said Othman; Hesham Samir Abdelaziz AbdelKawy Aggour; Samir Saleh Wafa; Mohamed El Sayed Zahran

doi:doi:10.11648/j.ccr.20190302.11

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Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention

Khaled Mohamed Said Othman, Hesham Samir Abdelaziz AbdelKawy Aggour, Samir Saleh Wafa, Mohamed El Sayed Zahran

Published in Cardiology and Cardiovascular Research (Volume 3, Issue 2)

Received: 30 March 2019 Accepted: 7 May 2019 Published: 11 June 2019

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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.

Published in	Cardiology and Cardiovascular Research (Volume 3, Issue 2)
DOI	10.11648/j.ccr.20190302.11
Page(s)	22-26
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

No-reflow, CRP/Albumin Ratio, Monocytes/HDL Ratio

References

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Khaled Mohamed Said Othman, Hesham Samir Abdelaziz AbdelKawy Aggour, Samir Saleh Wafa, Mohamed El Sayed Zahran. (2019). Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention. Cardiology and Cardiovascular Research, 3(2), 22-26. https://doi.org/10.11648/j.ccr.20190302.11

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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. Cardiol. Cardiovasc. Res. 2019, 3(2), 22-26. doi: 10.11648/j.ccr.20190302.11

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AMA Style

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. Cardiol Cardiovasc Res. 2019;3(2):22-26. doi: 10.11648/j.ccr.20190302.11

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@article{10.11648/j.ccr.20190302.11,
  author = {Khaled Mohamed Said Othman and Hesham Samir Abdelaziz AbdelKawy Aggour and Samir Saleh Wafa and Mohamed El Sayed Zahran},
  title = {Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention},
  journal = {Cardiology and Cardiovascular Research},
  volume = {3},
  number = {2},
  pages = {22-26},
  doi = {10.11648/j.ccr.20190302.11},
  url = {https://doi.org/10.11648/j.ccr.20190302.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20190302.11},
  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.},
 year = {2019}
}

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TY - JOUR
T1 - Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention
AU - Khaled Mohamed Said Othman
AU - Hesham Samir Abdelaziz AbdelKawy Aggour
AU - Samir Saleh Wafa
AU - Mohamed El Sayed Zahran
Y1 - 2019/06/11
PY - 2019
N1 - https://doi.org/10.11648/j.ccr.20190302.11
DO - 10.11648/j.ccr.20190302.11
T2 - Cardiology and Cardiovascular Research
JF - Cardiology and Cardiovascular Research
JO - Cardiology and Cardiovascular Research
SP - 22
EP - 26
PB - Science Publishing Group
SN - 2578-8914
UR - https://doi.org/10.11648/j.ccr.20190302.11
AB - 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.
VL - 3
IS - 2
ER -

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Author Information

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

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Khaled Mohamed Said Othman, Hesham Samir Abdelaziz AbdelKawy Aggour, Samir Saleh Wafa, Mohamed El Sayed Zahran. (2019). Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention. Cardiology and Cardiovascular Research, 3(2), 22-26. https://doi.org/10.11648/j.ccr.20190302.11

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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. Cardiol. Cardiovasc. Res. 2019, 3(2), 22-26. doi: 10.11648/j.ccr.20190302.11

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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. Cardiol Cardiovasc Res. 2019;3(2):22-26. doi: 10.11648/j.ccr.20190302.11

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@article{10.11648/j.ccr.20190302.11,
  author = {Khaled Mohamed Said Othman and Hesham Samir Abdelaziz AbdelKawy Aggour and Samir Saleh Wafa and Mohamed El Sayed Zahran},
  title = {Predictors of No-reflow Phenomenon in ST-elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention},
  journal = {Cardiology and Cardiovascular Research},
  volume = {3},
  number = {2},
  pages = {22-26},
  doi = {10.11648/j.ccr.20190302.11},
  url = {https://doi.org/10.11648/j.ccr.20190302.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20190302.11},
  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.},
 year = {2019}
}

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