Serum Endocan Levels Predict Angiographic No-Reflow Phenomenon in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Coronary Intervention

Angiology ◽  
2020 ◽  
pp. 000331972096195
Author(s):  
Mustafa Dogdus ◽  
Mustafa Yenercag ◽  
Mehmet Ozyasar ◽  
Ahmet Yilmaz ◽  
Levent Hurkan Can ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Independent Predictor ◽  
Area Under The Curve ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

No-reflow phenomenon (NRP) is an important problem in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Endocan is synthesized and secreted by activated vascular endothelium, and it has been shown to be related to endothelial dysfunction and inflammation. We aimed to evaluate the relationship between endocan levels and NRP. Consecutive patients (n = 137) with STEMI who had undergone coronary angiography and pPCI were enrolled into the study. The clinical characteristics of the patients were obtained and endocan levels were measured. Endocan levels were significantly higher in the NRP (+) group compared with the NRP (−) group ( P < .001). In multivariate analysis, endocan ( P < .001, OR = 2.39, 95% CI = 1.37-4.15) was found to be an independent predictor of NRP. An endocan value of >2.7 ng/mL has 89.6% sensitivity and 74.2% specificity for the prediction of the NRP (area under the curve: 0.832, P < .001). The present study demonstrated that the endocan level is an independent predictor of the NRP in patients with STEMI who underwent pPCI. Endocan levels may be helpful in detecting patients with a higher risk of insufficient myocardial perfusion and worse clinical outcome.

No-reflow phenomenon in ST-segment elevation myocardial infarction: still the Achilles’ heel of the interventionalist

2020 ◽  
Author(s):  
Jonathan L Ciofani ◽  
Usaid K Allahwala ◽  
Roberto Scarsini ◽  
Avedis Ekmejian ◽  
Adrian P Banning ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon ◽  
Management Algorithms

Improvements in systems, technology and pharmacotherapy have significantly changed the prognosis over recent decades in patients presenting with ST-segment elevation myocardial infarction. These clinical achievements have, however, begun to plateau and it is becoming increasingly necessary to consider novel strategies to further improve outcomes. Approximately a third of patients treated by primary percutaneous coronary intervention for ST-segment elevation myocardial infarction will suffer from coronary no-reflow (NR), a condition characterized by poor myocardial perfusion despite patent epicardial arteries. The presence of NR impacts significantly on clinical outcomes including left ventricular dysfunction, heart failure and death, yet conventional management algorithms neither assess the risk of NR nor treat NR. This review will provide a contemporary overview on the pathogenesis, diagnosis and treatment of NR.

The value of plasma D-dimer level in predicting no-reflow after primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Wafed Samir Mohamed Elsymbokhty ◽  
Hazem Mohamed Mansour ◽  
Ahmed Fathy Tamara ◽  
Ali Ahmed Alabd
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
University Hospital ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon ◽  
D Dimer

Abstract Background The no-reflow phenomenon is defined as the occurrence of areas with extremely low tissue flow after reopening the target vessel. Current knowledge suggests that the no-reflow phenomenon is caused by the damage to microvascular integrity established both during ischemia and during reperfusion.. D-dimer is a final product of fibrin degradation by plasmin, the plasma concentrations of which increase in subjects with ongoing or recent thrombosis; its levels reflect the fibrin turnover and gives an indirect estimation of the size of the thrombotic mass available for fibrinolysis and the severity of hypercoagulable state. Moreover, high thrombus burden is known to be associated with no-reflow phenomenon. Objective: To determine the value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction, Patients and Methods The study was conducted among 100 patients with STEMI admitted in coronary care unit and coronary catheterization lab unit of cardiology department in Ain Shams University Hospital & Misr University Hospital undergone successful primary PCI. 74 patients showed normal re-flow after PCI and 26 patients showed noreflow phenomenon after PCI and D –dimer level and other clinical parematers for the no re-flow phenomenon were analysed. Results patient with high plasma D-dimer levels showed higher risk of no-reflow phenomenon compared with patients with low plasma D-dimer in predicting no-reflow. D-dimer level ranged from 210 to 776 ng/ml with mean± SD was 415.35 ± 164.91 ng/ml. (55%) of the patients had D-dimer levels &lt;500 ng/ml.and (45%) had D-dimer &gt;500ng/dl. coronary angiography showed that (74%) showed normal flow and (26%)showed no re-flow. ROC curve of the relation of no-reflow, TIMI flow and MBG grade, showed that the best cut off point for D-dimer to detect cases with no reflow was found ≥ 560 with sensitivity of 96.15%, specificity of 79.73% and area under curve (AUC) of 86.5%. Conclusion D-dimer level on admission independently predicts no-reflow after p-PCI. High D-dimer level on admission has an independent prognostic value.

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