The No-reflow Phenomenon: Is it Predictable by Demographic factors and Routine Laboratory Data?
Keywords:
Myocardial infarction, Percutaneous coronary intervention, No-reflow phenomenonAbstract
Background:The coronary no-reflow phenomenon is an adverse complication of percutaneous coronary interventions (PCI) which significantly worsens the outcome and survival. In this study, we have evaluated the correlation of no-reflow phenomenon with demographic, biochemical and anatomical factors.
Methods: We included 306 patients (193 male) with acute ST-elevation myocardial infarction (STEMI) who undergone primary PCI in our center. Demographic factors, as well as biochemistry test results were obtained. Also, the Thrombolysis in Myocardial Infarction (TIMI) grade and TIMI frame count (TFC) was measured. The correlation of no-reflow phenomenon with demographic, biochemical and anatomical factors was analyzed.
Results: Patients with a mean age of 56.41 ± 11.8 years were divided into two groups depending on the TIMI score (Group 1 or Normal flow and Group 2 or No-reflow). Symptom-to-procedure time, door-to-procedure time, serum creatinine level, hs-CRP level, and Neutrophil to Lymphocyte Ratio (NLR) were significantly higher among group 2. TFC had negative significant correlation with male gender, and positive significant correlation with age, diabetes mellitus, hs-CRP level, WBC count, and NLR. Age of more than 62.5 years and serum creatinine level of more than 0.89 mg/dL can optimally predict the no reflow phenomena.
Conclusions: According to our results, it seems that female gender, older ages, DM, multi-vessel involvement, delayed reperfusion, and increased NLR can predict the risk of no-reflow after primary PCI in the setting of Acute Myocardial Infarction.
References
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15. Wang L, Cheng Z, Gu Y, Peng D. Short-Term Effects of Verapamil and Diltiazem in the Treatment of No Reflow Phenomenon: A Meta-Analysis of Randomized Controlled Trials. Biomed Res Int. 2015;2015:382086.
16. Aung Naing K, Li L, Su Q, Wu T. Adenosine and verapamil for no-reflow during primary percutaneous coronary intervention in people with acute myocardial infarction. Cochrane Database Syst Rev. 2013(6):CD009503.
17. Wang HJ, Lo PH, Lin JJ, Lee H, Hung JS. Treatment of slow/no-reflow phenomenon with intracoronary nitroprusside injection in primary coronary intervention for acute myocardial infarction. Catheter Cardiovasc Interv. 2004;63(2):171-6.
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20. Rezkalla SH, Stankowski RV, Hanna J, Kloner RA. Management of No-Reflow Phenomenon in the Catheterization Laboratory. JACC Cardiovasc Interv. 2017;10(3):215-23.
21. Gibson CM, Cannon CP, Daley WL, Dodge JT, Jr., Alexander B, Jr., Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879-88.
22. Krug A, Du Mesnil de R, Korb G. Blood supply of the myocardium after temporary coronary occlusion. Circ Res. 1966;19(1):57-62.
23. Zhang D, Song X, Lv S, Li D, Yan S, Zhang M. Predicting coronary no-reflow in patients with acute ST-segment elevation myocardial infarction using Bayesian approaches. Coron Artery Dis. 2014;25(7):582-8.
24. Kurtul A, Murat SN, Yarlioglues M, Duran M, Celik IE, Kilic A. Mild to Moderate Renal Impairment Is Associated With No-Reflow Phenomenon After Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction. Angiology. 2015;66(7):644-51.
25. Magro M, Springeling T, van Geuns RJ, Zijlstra F. Myocardial 'no-reflow' prevention. Curr Vasc Pharmacol. 2013;11(2):263-77.
26. Celermajer DS, Sorensen KE, Spiegelhalter DJ, Georgakopoulos D, Robinson J, Deanfield JE. Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol. 1994;24(2):471-6.
27. Kurtul A, Acikgoz SK. Usefulness of Mean Platelet Volume-to-Lymphocyte Ratio for Predicting Angiographic No-Reflow and Short-Term Prognosis After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2017;120(4):534-41.
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29. Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol. 2012;110(5):621-7.
30. Balta S, Celik T, Ozturk C, Kaya MG, Aparci M, Yildirim AO, et al. 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. 2016;34(8):1542-7.
31. Yildiz A, Yilmaz R, Demirbag R, Gur M, Bas MM, Erel O. Association of serum uric acid level and coronary blood flow. Coron Artery Dis. 2007;18(8):607-13.
32. Barrett-Connor E. Sex differences in coronary heart disease. Why are women so superior? The 1995 Ancel Keys Lecture. Circulation. 1997;95(1):252-64.
33. Fajar JK, Heriansyah T, Rohman MS. The predictors of no reflow phenomenon after percutaneous coronary intervention in patients with ST elevation myocardial infarction: A meta-analysis. Indian Heart J. 2018;70 Suppl 3:S406-S18.
34. Yan L, Ye L, Wang K, Zhou J, Zhu C. [Atorvastatin improves reflow after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction by decreasing serum uric acid level]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2016;45(5):530-5.
35. Tabit CE, Chung WB, Hamburg NM, Vita JA. Endothelial dysfunction in diabetes mellitus: molecular mechanisms and clinical implications. Rev Endocr Metab Disord. 2010;11(1):61-74.
36. Puddu P, Puddu GM, Zaca F, Muscari A. Endothelial dysfunction in hypertension. Acta Cardiol. 2000;55(4):221-32.
37. Ross R. Atherosclerosis is an inflammatory disease. Am Heart J. 1999;138(5 Pt 2):S419-20.
38. Garg AX, Clark WF, Haynes RB, House AA. Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I. Kidney Int. 2002;61(4):1486-94.
39. Rezkalla SH, Kloner RA. No-reflow phenomenon. Circulation. 2002;105(5):656-62.
40. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105(9):1135-43.
41. Tomoda H, Aoki N. Prognostic value of C-reactive protein levels within six hours after the onset of acute myocardial infarction. Am Heart J. 2000;140(2):324-8.
42. Magadle R, Hertz I, Merlon H, Weiner P, Mohammedi I, Robert D. The relation between preprocedural C-reactive protein levels and early and late complications in patients with acute myocardial infarction undergoing interventional coronary angioplasty. Clin Cardiol. 2004;27(3):163-8.
43. Celik T, Iyisoy A, Kursaklioglu H, Turhan H, Kilic S, Kose S, et al. The impact of admission C-reactive protein levels on the development of poor myocardial perfusion after primary percutaneous intervention in patients with acute myocardial infarction. Coron Artery Dis. 2005;16(5):293-9.
44. Hong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY, et al. Predictors of no-reflow after percutaneous coronary intervention for culprit lesion with plaque rupture in infarct-related artery in patients with acute myocardial infarction. J Cardiol. 2009;54(1):36-44.
45. Niccoli G, Lanza GA, Spaziani C, Altamura L, Romagnoli E, Leone AM, et al. Baseline systemic inflammatory status and no-reflow phenomenon after percutaneous coronary angioplasty for acute myocardial infarction. Int J Cardiol. 2007;117(3):306-11.
46. Saugstad OD. Role of xanthine oxidase and its inhibitor in hypoxia: reoxygenation injury. Pediatrics. 1996;98(1):103-7.
47. Neogi T, George J, Rekhraj S, Struthers AD, Choi H, Terkeltaub RA. Are either or both hyperuricemia and xanthine oxidase directly toxic to the vasculature? A critical appraisal. Arthritis and rheumatism. 2012;64(2):327-38.
48. Khosla UM, Zharikov S, Finch JL, Nakagawa T, Roncal C, Mu W, et al. Hyperuricemia induces endothelial dysfunction. Kidney Int. 2005;67(5):1739-42.
49. Farquharson CA, Butler R, Hill A, Belch JJ, Struthers AD. Allopurinol improves endothelial dysfunction in chronic heart failure. Circulation. 2002;106(2):221-6.
50. Kumbhalkar S, Deotale R. Association between Serum Uric Acid Level with Presence and Severity of Coronary Artery Disease. J Assoc Physicians India. 2019;67(4):29-32.
51. Sinan Deveci O, Kabakci G, Okutucu S, Tulumen E, Aksoy H, Baris Kaya E, et al. The association between serum uric acid level and coronary artery disease. Int J Clin Pract. 2010;64(7):900-7.
52. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431-46.
53. Vakili H, Shirazi M, Charkhkar M, Khaheshi I, Memaryan M, Naderian M. Correlation of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with thrombolysis in myocardial infarction frame count in ST-segment elevation myocardial infarction. European journal of clinical investigation. 2017;47(4):322-7.
54. Vakili H, Khaheshi I, Sharifi A, Nickdoost N, Namazi MH, Safi M, et al. Assessment of admission time cell blood count (CBC) parameters in predicting post- primary percutaneous coronary intervention TIMI frame count in patients with ST-segment elevation myocardial infarction. Cardiovascular & hematological disorders drug targets. 2020.
55. Celermajer DS, Sorensen KE, Barley J, Jeffrey S, Carter N, Deanfield J. Angiotensin-converting enzyme genotype is not associated with endothelial dysfunction in subjects without other coronary risk factors. Atherosclerosis. 1994;111(1):121-6.
56. Hearse DJ, Bolli R. Reperfusion induced injury: manifestations, mechanisms, and clinical relevance. Cardiovasc Res. 1992;26(2):101-8.
2. Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention. Circulation. 2008;117(24):3152-6.
3. Zhao JL, Yang YJ, Pei WD, Sun YH, Chen JL. The effect of statins on the no-reflow phenomenon: an observational study in patients with hyperglycemia before primary angioplasty. Am J Cardiovasc Drugs. 2009;9(2):81-9.
4. Li X, Li B, Gao J, Wang Y, Xue S, Jiang D, et al. Influence of angiographic spontaneous coronary reperfusion on long-term prognosis in patients with ST-segment elevation myocardial infarction. Oncotarget. 2017;8(45):79767-74.
5. Akpek M, Kaya MG, Uyarel H, Yarlioglues M, Kalay N, Gunebakmaz O, et al. The association of serum uric acid levels on coronary flow in patients with STEMI undergoing primary PCI. Atherosclerosis. 2011;219(1):334-41.
6. Cenko E, Ricci B, Kedev S, Kalpak O, Calmac L, Vasiljevic Z, et al. The no-reflow phenomenon in the young and in the elderly. Int J Cardiol. 2016;222:1122-8.
7. Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. J Am Coll Cardiol. 2009;54(4):281-92.
8. Harrison RW, Aggarwal A, Ou FS, Klein LW, Rumsfeld JS, Roe MT, et al. Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction. Am J Cardiol. 2013;111(2):178-84.
9. Abbo KM, Dooris M, Glazier S, O'Neill WW, Byrd D, Grines CL, et al. Features and outcome of no-reflow after percutaneous coronary intervention. Am J Cardiol. 1995;75(12):778-82.
10. Dong-bao L, Qi H, Zhi L, Shan W, Wei-ying J. Predictors and long-term prognosis of angiographic slow/no-reflow phenomenon during emergency percutaneous coronary intervention for ST-elevated acute myocardial infarction. Clin Cardiol. 2010;33(12):E7-12.
11. Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H, et al. 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. 2000;36(4):1202-9.
12. Resnic FS, Wainstein M, Lee MK, Behrendt D, Wainstein RV, Ohno-Machado L, et al. No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J. 2003;145(1):42-6.
13. Wong DT, Puri R, Richardson JD, Worthley MI, Worthley SG. Myocardial 'no-reflow'--diagnosis, pathophysiology and treatment. Int J Cardiol. 2013;167(5):1798-806.
14. Fischell TA, Haller S, Pulukurthy S, Virk IS. Nicardipine and adenosine "flush cocktail" to prevent no-reflow during rotational atherectomy. Cardiovasc Revasc Med. 2008;9(4):224-8.
15. Wang L, Cheng Z, Gu Y, Peng D. Short-Term Effects of Verapamil and Diltiazem in the Treatment of No Reflow Phenomenon: A Meta-Analysis of Randomized Controlled Trials. Biomed Res Int. 2015;2015:382086.
16. Aung Naing K, Li L, Su Q, Wu T. Adenosine and verapamil for no-reflow during primary percutaneous coronary intervention in people with acute myocardial infarction. Cochrane Database Syst Rev. 2013(6):CD009503.
17. Wang HJ, Lo PH, Lin JJ, Lee H, Hung JS. Treatment of slow/no-reflow phenomenon with intracoronary nitroprusside injection in primary coronary intervention for acute myocardial infarction. Catheter Cardiovasc Interv. 2004;63(2):171-6.
18. Grygier M, Araszkiewicz A, Lesiak M, Grajek S. Role of adenosine as an adjunct therapy in the prevention and treatment of no-reflow phenomenon in acute myocardial infarction with ST segment elevation: review of the current data. Kardiol Pol. 2013;71(2):115-20.
19. Silva-Orrego P, Colombo P, Bigi R, Gregori D, Delgado A, Salvade P, et al. Thrombus aspiration before primary angioplasty improves myocardial reperfusion in acute myocardial infarction: the DEAR-MI (Dethrombosis to Enhance Acute Reperfusion in Myocardial Infarction) study. J Am Coll Cardiol. 2006;48(8):1552-9.
20. Rezkalla SH, Stankowski RV, Hanna J, Kloner RA. Management of No-Reflow Phenomenon in the Catheterization Laboratory. JACC Cardiovasc Interv. 2017;10(3):215-23.
21. Gibson CM, Cannon CP, Daley WL, Dodge JT, Jr., Alexander B, Jr., Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879-88.
22. Krug A, Du Mesnil de R, Korb G. Blood supply of the myocardium after temporary coronary occlusion. Circ Res. 1966;19(1):57-62.
23. Zhang D, Song X, Lv S, Li D, Yan S, Zhang M. Predicting coronary no-reflow in patients with acute ST-segment elevation myocardial infarction using Bayesian approaches. Coron Artery Dis. 2014;25(7):582-8.
24. Kurtul A, Murat SN, Yarlioglues M, Duran M, Celik IE, Kilic A. Mild to Moderate Renal Impairment Is Associated With No-Reflow Phenomenon After Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction. Angiology. 2015;66(7):644-51.
25. Magro M, Springeling T, van Geuns RJ, Zijlstra F. Myocardial 'no-reflow' prevention. Curr Vasc Pharmacol. 2013;11(2):263-77.
26. Celermajer DS, Sorensen KE, Spiegelhalter DJ, Georgakopoulos D, Robinson J, Deanfield JE. Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol. 1994;24(2):471-6.
27. Kurtul A, Acikgoz SK. Usefulness of Mean Platelet Volume-to-Lymphocyte Ratio for Predicting Angiographic No-Reflow and Short-Term Prognosis After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2017;120(4):534-41.
28. Celik T, Kaya MG, Akpek M, Gunebakmaz O, Balta S, Sarli B, et al. Predictive value of admission platelet volume indices for in-hospital major adverse cardiovascular events in acute ST-segment elevation myocardial infarction. Angiology. 2015;66(2):155-62.
29. Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol. 2012;110(5):621-7.
30. Balta S, Celik T, Ozturk C, Kaya MG, Aparci M, Yildirim AO, et al. 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. 2016;34(8):1542-7.
31. Yildiz A, Yilmaz R, Demirbag R, Gur M, Bas MM, Erel O. Association of serum uric acid level and coronary blood flow. Coron Artery Dis. 2007;18(8):607-13.
32. Barrett-Connor E. Sex differences in coronary heart disease. Why are women so superior? The 1995 Ancel Keys Lecture. Circulation. 1997;95(1):252-64.
33. Fajar JK, Heriansyah T, Rohman MS. The predictors of no reflow phenomenon after percutaneous coronary intervention in patients with ST elevation myocardial infarction: A meta-analysis. Indian Heart J. 2018;70 Suppl 3:S406-S18.
34. Yan L, Ye L, Wang K, Zhou J, Zhu C. [Atorvastatin improves reflow after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction by decreasing serum uric acid level]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2016;45(5):530-5.
35. Tabit CE, Chung WB, Hamburg NM, Vita JA. Endothelial dysfunction in diabetes mellitus: molecular mechanisms and clinical implications. Rev Endocr Metab Disord. 2010;11(1):61-74.
36. Puddu P, Puddu GM, Zaca F, Muscari A. Endothelial dysfunction in hypertension. Acta Cardiol. 2000;55(4):221-32.
37. Ross R. Atherosclerosis is an inflammatory disease. Am Heart J. 1999;138(5 Pt 2):S419-20.
38. Garg AX, Clark WF, Haynes RB, House AA. Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I. Kidney Int. 2002;61(4):1486-94.
39. Rezkalla SH, Kloner RA. No-reflow phenomenon. Circulation. 2002;105(5):656-62.
40. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105(9):1135-43.
41. Tomoda H, Aoki N. Prognostic value of C-reactive protein levels within six hours after the onset of acute myocardial infarction. Am Heart J. 2000;140(2):324-8.
42. Magadle R, Hertz I, Merlon H, Weiner P, Mohammedi I, Robert D. The relation between preprocedural C-reactive protein levels and early and late complications in patients with acute myocardial infarction undergoing interventional coronary angioplasty. Clin Cardiol. 2004;27(3):163-8.
43. Celik T, Iyisoy A, Kursaklioglu H, Turhan H, Kilic S, Kose S, et al. The impact of admission C-reactive protein levels on the development of poor myocardial perfusion after primary percutaneous intervention in patients with acute myocardial infarction. Coron Artery Dis. 2005;16(5):293-9.
44. Hong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY, et al. Predictors of no-reflow after percutaneous coronary intervention for culprit lesion with plaque rupture in infarct-related artery in patients with acute myocardial infarction. J Cardiol. 2009;54(1):36-44.
45. Niccoli G, Lanza GA, Spaziani C, Altamura L, Romagnoli E, Leone AM, et al. Baseline systemic inflammatory status and no-reflow phenomenon after percutaneous coronary angioplasty for acute myocardial infarction. Int J Cardiol. 2007;117(3):306-11.
46. Saugstad OD. Role of xanthine oxidase and its inhibitor in hypoxia: reoxygenation injury. Pediatrics. 1996;98(1):103-7.
47. Neogi T, George J, Rekhraj S, Struthers AD, Choi H, Terkeltaub RA. Are either or both hyperuricemia and xanthine oxidase directly toxic to the vasculature? A critical appraisal. Arthritis and rheumatism. 2012;64(2):327-38.
48. Khosla UM, Zharikov S, Finch JL, Nakagawa T, Roncal C, Mu W, et al. Hyperuricemia induces endothelial dysfunction. Kidney Int. 2005;67(5):1739-42.
49. Farquharson CA, Butler R, Hill A, Belch JJ, Struthers AD. Allopurinol improves endothelial dysfunction in chronic heart failure. Circulation. 2002;106(2):221-6.
50. Kumbhalkar S, Deotale R. Association between Serum Uric Acid Level with Presence and Severity of Coronary Artery Disease. J Assoc Physicians India. 2019;67(4):29-32.
51. Sinan Deveci O, Kabakci G, Okutucu S, Tulumen E, Aksoy H, Baris Kaya E, et al. The association between serum uric acid level and coronary artery disease. Int J Clin Pract. 2010;64(7):900-7.
52. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431-46.
53. Vakili H, Shirazi M, Charkhkar M, Khaheshi I, Memaryan M, Naderian M. Correlation of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with thrombolysis in myocardial infarction frame count in ST-segment elevation myocardial infarction. European journal of clinical investigation. 2017;47(4):322-7.
54. Vakili H, Khaheshi I, Sharifi A, Nickdoost N, Namazi MH, Safi M, et al. Assessment of admission time cell blood count (CBC) parameters in predicting post- primary percutaneous coronary intervention TIMI frame count in patients with ST-segment elevation myocardial infarction. Cardiovascular & hematological disorders drug targets. 2020.
55. Celermajer DS, Sorensen KE, Barley J, Jeffrey S, Carter N, Deanfield J. Angiotensin-converting enzyme genotype is not associated with endothelial dysfunction in subjects without other coronary risk factors. Atherosclerosis. 1994;111(1):121-6.
56. Hearse DJ, Bolli R. Reperfusion induced injury: manifestations, mechanisms, and clinical relevance. Cardiovasc Res. 1992;26(2):101-8.
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Namazi M, Mahmoudi E, Safi M, Jenab Y, Vakili H, Saadat H, et al. The No-reflow Phenomenon: Is it Predictable by Demographic factors and Routine Laboratory Data?. Acta Biomed [Internet]. 2021 Nov. 3 [cited 2024 Jul. 17];92(5):e2021297. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/10053
