scholarly journals Correlates of the “No-Reflow” or “Slow-Flow” Phenomenon in Patients Undergoing Primary Percutaneous Coronary Intervention

2018 ◽  
Author(s):  
Mohammad Alidoosti ◽  
Reza Lotfi ◽  
Masoumeh Lotfi-Tokaldany ◽  
Ebrahim Nematipour ◽  
Mojtaba Salarifar ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Slow Flow ◽  
Primary Pci ◽  
No Reflow ◽  
Timi Flow ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon ◽  
Infarct Related Artery

Background: Despite recent advances in interventional equipment and techniques, the angiographic no-reflow phenomenon occurs in a considerable number of patients undergoing primary percutaneous coronary intervention (PCI). We investigated the clinical, angiographic, preprocedural, and procedural characteristics associated with the no-reflow phenomenon among patients undergoing primary PCI. Methods: Between March 2008 and April 2013, 530 patients (78.5% male, mean age=58.11±12.39 y) with ST-segment-elevation myocardial-infarction who underwent primary PCI were categorized in 2 groups according to their postprocedural thrombolysis-in-myocardial infarction (TIMI) flow grades:  those with a maximum score of 2 (the no-reflow or slow-flow group) and the ones with a score of 3 (the reflow group). A multivariable logistic regression model was used to find the multiple correlates of the no-reflow phenomenon after PCI. Results: There were 166 (31.3%) patients in the no-reflow group and 364 (68.7%) in the reflow group. The no-reflow patients were older and had significantly longer target lesion lengths, higher SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) scores, higher infarct-related artery SYNTAX scores, more thrombus burden, and a higher frequency of initial TIMI flow grades of 2 or lower. Our multivariable logistic regression analysis demonstrated that older age, higher numbers of Q waves, not using statin, longer target lesion lengths, higher thrombus grades, and higher infarct-related artery SYNTAX scores remained the independent correlates of increased no-reflow rates after primary PCI (area under the ROC curve=0.784,  95% CI: 0.742–0.826; P<0.001). Conclusion: Clinical, angiographic, and procedural features of patients undergoing primary PCI may be correlated with the occurrence of the no-reflow phenomenon. The thrombus grade and the infarct-related artery SYNTAX score could be among these factors.

scholarly journals Circulating miR-660-5p is associated with no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention

2020 ◽  
Author(s):  
Jian-Wei zhang ◽  
Cheng-Ping Hu ◽  
Ying-Xin Zhao ◽  
Ling-Jie He
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Characteristic Curve ◽  
Linear Regression Analysis ◽  
Coronary Intervention ◽  
No Reflow ◽  
Timi Flow ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Abstract Background: The no-reflow phenomenon (NRP) is an important factor affecting the prognosis of patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). This study aims to investigate the association of circulating miR-660-5p with NRP in patients with ST segment elevation myocardial infarction (STEMI) undergoing PPCI.Methods: Consecutive patients diagnosed with anterior STEMI within 12 h of pain onset were included in the study; in these patients, coronary angiography confirmed that the infarct-related artery was the left anterior descending (LAD) artery. Angiographic NRP was defined as a final TIMI flow of 2 or a final TIMI flow of 3 with a myocardial blush grade (MBG) < 2. High miR-660-5p was defined as a value in the third tertile. The relationship of circulating miR-660-5p with NRP was assessed using Spearman correlation analysis and multiple linear regression analysis.Results: Fifty-two eligible patients were finally included in this study (mean age: 56±12.4 years, >65 years: 53.8%, male: 76.9%, and mean BMI: 26.3±3.5). The incidence of NRP was 38.5%. Circulating miR-660-5p was significantly related to the mean platelet volume (MPV). Patients were divided into tertiles by miR-660-5p levels (Q1: ≤ 7.18, Q2: 7.18-11.31, Q3: > 11.31). Patients in the high microRNA-660-5p group had almost a 6-fold higher risk of NRP than those in the low microRNA-660-5p group [(odds ratio (OR)=5.68, 95% confidence interval (CI) 1.40-23.07, p=0.015). When analysed by tertiles, consistent trends of an increasing relative odds of NRP were reported (OR1 for Q2 VS. Q1: 1.25, 95% CI: 0.27-5.73, p=0.77; OR2 for Q3 VS. Q1: 5.96, 95% CI: 1.33-26.66, p=0.02), even after multivariable adjustment. Receiver operating characteristic curve analysis demonstrated that the microRNA-660-5p level of 10.17 was the best cut-off level to predict the incidence of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention with an area under the curve (AUC) of 0.768 (95% CI: 0.636-0.890).Conclusion: Circulating miR-660-5p was significantly associated with NRP, and it may be a useful biomarker to predict the incidence of NRP in patients with STEMI undergoing PPCI.

scholarly journals Circulating miR-660-5p is associated with the no-reflow phenomenon in patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

2020 ◽  
Author(s):  
jian-wei zhang ◽  
Cheng-ping Hu ◽  
Ying-xin Zhao ◽  
Ling-jie He
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
No Reflow ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Abstract Background: The no-reflow phenomenon (NRP) is an important factor affecting the prognosis of patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). This study aims to investigate the association of circulating miR-660-5p with NRP in patients with ST segment elevation myocardial infarction (STEMI) undergoing PPCI.Methods: Consecutive patients diagnosed with anterior STEMI within 12 h of pain onset were included in the study; in these patients, coronary angiography confirmed that the infarct-related artery was the left anterior descending (LAD) artery. Angiographic NRP was defined as a final TIMI flow of 2 or a final TIMI flow of 3 with a myocardial blush grade (MBG) < 2. High miR-660-5p was defined as a value in the third tertile. The relationship of circulating miR-660-5p with NRP was assessed using Spearman correlation analysis and multiple logistic regression analysis.Results: Fifty-two eligible patients were finally included in this study (mean age: 56±12.4 years, >65 years: 53.8%, male: 76.9%, and mean BMI: 26.3±3.5). The incidence of NRP was 38.5%. Circulating miR-660-5p was significantly related to the mean platelet volume (MPV). Patients were divided into tertiles by miR-660-5p levels (Q1: ≤ 7.18, Q2: 7.18-11.31, Q3: > 11.31). Patients in the high microRNA-660-5p group had almost a 6-fold higher risk of NRP than those in the low microRNA-660-5p group [(odds ratio (OR)=5.68, 95% confidence interval (CI) 1.40-23.07, p=0.015). When analysed by tertiles, consistent trends of an increasing relative odds of NRP were reported (OR1 for Q2 VS. Q1: 1.25, 95% CI: 0.27-5.73, p=0.77; OR2 for Q3 VS. Q1: 5.96, 95% CI: 1.33-26.66, p=0.02), even after multivariable adjustment. Receiver operating characteristic curve analysis demonstrated that the microRNA-660-5p level of 10.17 was the best cut-off level to predict the incidence of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention with an area under the curve (AUC) of 0.768 (95% CI: 0.636-0.890).Conclusion: Circulating miR-660-5p was significantly associated with NRP, and it may be a useful biomarker to predict the incidence of NRP in patients with STEMI undergoing PPCI.

Vitamin D level predicts angiographic no-reflow phenomenon after percutaneous coronary intervention in patients with ST segment elevation myocardial infarction

2021 ◽  
Vol 15 (15) ◽  
pp. 1357-1366
Author(s):  
Ömer Şen ◽  
Sıdıka B Şen ◽  
Ayşe N Topuz ◽  
Mustafa Topuz
Keyword(s):  
Myocardial Infarction ◽  
Vitamin D ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Normal Flow ◽  
Timi Flow Grade ◽  
No Reflow ◽  
Timi Flow ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Aim: No-reflow phenomenon (NRP) is an undesirable result of coronary interventions, and usually occurred during the primary percutaneous coronary intervention (PPCI). On the other hand, there is growing evidence of epidemiological studies suggest that serum 25 hydroxy-vitamin D (25(OH)D3) level is significantly associated with cardiovascular mortality and morbidity. Objective: To investigate whether there is a relationship between admission serum 25(OH)D3 levels and NRP in patients with ST elevation myocardial infarction (STEMI). Methods: This study consisted of 496 consecutive acute STEMI patients who underwent PPCI. After the restoration of antegrade flow, the patients were divided into the normal flow and no-reflow groups. No-reflow defined as; thrombosis in myocardial infarction (TIMI) flow grade ≤2, or a TIMI flow grade = 3 with a myocardial perfusion grade ≤1. Results: Angiographic no-reflow occurred 18.2% of all study patients. Serum 25(OH)D3 levels were significantly lower when compared with the normal flow group (14.6 ± 7.3 vs 22.6 ± 9.6 ng/ml; p < 0.001). 25(OH)D3 level was significantly negatively correlated with Neutrophil/lymphocyte (N/L) ratio. In multivariate analysis, 25(OH)D3 level on admission (OR: 0.738; 95% CI: 0.584–0.878; p = 0.001) was found an independent predictor of NRP together with N/L ratio, N-Terminal-proBNP, balloon pre dilatation and syntax score I. On receiver operating curve analysis (ROC), the cut-off value of admission 25(OH)D3 level was 10.5 ng/ml for the prediction of NRP with a sensitivity of 93% and specificity of 68%. The area under the ROC curve (AUC) was 0.772 (95% CI: 0.697–0.846; p < 0.001). Conclusion: We have shown that lower 25(OH)D3 level on admission is associated with higher NRP frequency and may be used as a predictor for NRP in STEMI patients undergoing PPCI.

scholarly journals Circulating miR-660-5p is associated with no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention

2020 ◽  
Author(s):  
jian-wei zhang ◽  
Cheng-ping Hu ◽  
Ying-xin Zhao ◽  
Ling-jie He
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Independent Predictor ◽  
Linear Regression Analysis ◽  
Coronary Intervention ◽  
No Reflow ◽  
Timi Flow ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Abstract Background No-reflow phenomenon (NRP) is an important factor affecting the prognosis of patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). This study aims to investigate the association of circulating miR-660-5p with NRP in ST segment elevation myocardial infarction (STEMI) undergoing PPCI. Methods 52 eligible consecutive patients diagnosed with anterior STEMI within 12h of pain onset, which coronary angiography confirms that infarct-related artery is left anterior descending artery (LAD), were included in this study. Angiographic NRP is define as the final TIMI flow of 2 or the final TIMI flow of 3 with myocardial blush grade (MBG) of <2.Effect of circulating miR-660-5p on NRP was assessed using Spearman correlation analysis and multiple linear regression analysis. Results The incidence of NRP was 38.5%. Patients with higher miR-660-5p levels have significantly higher incidence of coronary NRP. At multivariable analysis, circulating miR-660-5p remained an independent predictor of NRP (odds ratio [OR]=1.34, 95%CI 1.10 to 1.63, p=0.004). Patients in higher microRNA-660-5p levels group have almost a 6-fold higher risk of NRP than that in lower microRNA-660-5p group (OR=5.68, 95%CI 1.40 to 23.07, p=0.015). When analyzed by tertiles, consistent trends of increasing relative odds of NRP were reported (OR1 for Q2 VS. Q1: 1.25,95%CI: 0.27-5.73, p=0.77;OR2 for Q3 VS. Q1: 5.96,95%CI: 1.33-26.66, p=0.02). Circulating miR-660-5p was related to MPV significantly. Conclusion Circulating miR-660-5p is an independent predictor of NRP in STEMI patients undergoing PPCI.

scholarly journals Mean platelet volume-to-lymphocyte ratio as a predictor of no-reflow phenomenon and in-hospital mortality following primary percutaneous coronary intervention in patients with STEMI

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H A Willim ◽  
K R Sari ◽  
H Cipta
Keyword(s):  
Systematic Review ◽  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Platelet Volume ◽  
No Reflow ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon

Abstract Background ST-segment elevation myocardial infarction (STEMI) is the most severe form of acute coronary syndrome. Primary percutaneous coronary intervention (PCI) is currently the treatment of choice for STEMI. However, many factors can influence the outcomes of primary PCI. Inflammation and platelet activation play a vital role in the development of complications following primary PCI. Recently, the mean platelet volume-to-lymphocyte ratio (MPVLR) has emerged as a novel biomarker of worse outcomes linking inflammation and thrombosis. Purpose The aim of this study was to conduct a systematic review and meta-analysis to investigate the prognostic value of MPVLR as a predictor of no-reflow phenomenon and in-hospital mortality following primary PCI in patients with STEMI. Methods A systematic literature search was performed in the databases of PubMed, ScienceDirect, ProQuest, and Google Scholar. The primary outcomes were no-reflow phenomenon and in-hospital mortality following primary PCI for STEMI. The outcomes were compared between patients with high and low MPVLR at admission. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. The Review Manager 5.3 was used to perform the meta-analysis. Results Four cohort studies involving 3038 patients with STEMI undergoing primary PCI were included in this meta-analysis. The pooled analysis showed that a high MPVLR at admission was associated with higher no-reflow phenomenon (odds ratio [OR] = 4.54, 95% confidence interval [CI]: 2.45–8.41, P&lt;0.ehab724.13681, I2=86%) and higher in-hospital mortality (OR=2.69, 95% CI: 1.96–3.68, P&lt;0.ehab724.13681, I2=0%) following primary PCI. Conclusions This systematic review and meta-analysis showed that a high MPVLR predicts no-reflow phenomenon and in-hospital mortality following primary PCI in patients with STEMI. FUNDunding Acknowledgement Type of funding sources: None. MPVLR and no-reflow phenomenon MPVLR and in-hospital mortality

scholarly journals Deferred Stenting for Heavy Thrombus Burden During Percutaneous Coronary Intervention for ST-Elevation MI

2021 ◽  
Vol 16 ◽  
Author(s):  
Akshyaya Pradhan ◽  
Monika Bhandari ◽  
Pravesh Vishwakarma ◽  
Rishi Sethi
Keyword(s):  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Slow Flow ◽  
No Reflow ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon ◽  
Infarct Related Artery ◽  
Final Infarct Size ◽  
St Elevation ◽  
Meta Analyses

Patients with ST-elevation MI (STEMI) usually have a huge thrombus burden in the infarct-related artery. Stenting may lead to high chances of the slow-flow/no-reflow phenomenon that leads to periprocedural MI and adverse cardiovascular events. Deferred stenting may be beneficial in this situation as the thrombus burden will reduce, mitigating the slow-flow/no-reflow phenomenon. However, routine deferral of stenting in patients with STEMI has not been found to be beneficial, but when the patient is properly selected, deferred stenting has the potential for reducing the final infarct size. The authors report the safety and feasibility of deferred stenting after 5 days of prolonged anticoagulation in a 45-year-old smoker with STEMI who had a large thrombus load shown on an angiogram. They review the registries, trials and meta-analyses on deferred stenting in the literature and analyse the benefits and harms of the strategy. They also propose an algorithm for applying a strategy for deferred stenting in clinical practice based on the available data.

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