Relation Between Serum Procalcitonin Level And No Reflow Phenomenon In STEMI Patients After PCI

Background and ObjectivesCoronary heart disease(CHD)has the leading cause of mortality and causes millions of deaths worldwide every year.In recent years,the mortality and morbidity of acute coronary syndromes(ACS),especially acute ST-segment elevation myocardial infarction(STEMI),are rapidly increasing in China.Acute myocardial ischemic necrosis is the key pathologic characteristic of STEMI.As for patients with STEMI,prompt recanalization of the infarct-related artery(IRA)is the first-line therapy to achieve myocardial microvascular reperfusion.However,in some patients with STEMI and successful IRA recanalization,myocardial perfusion was not improved.This phenomenon was defined as “no-reflow”(NRP),which significantly increased the mortality of patients with STEMI.There are several risk factors for the occurance of NRP.Inflammatory reaction is a well-known risk factor for NRP.Several studies demonstrated that the levels of hs-CRP and the ratio of neutrophils / lymphocytes increased in patients with NRP.As another inflammatory factor,procalcitonin is usually used as a specific marker of infection.The present study was designed to evaluate the prediction value of procalcitonin in PCI related NRP.MethodsEighty-three patients with STEMI were consecutively and prospectively enrolled in the Department of cardiology and the Department of emergency in Xijing Hospital from May 2017 to November 2017.Patients characteristics and PCT levels were recorded.These patients were divided into two groups: no-reflow group(n=23)and control group(n=60).The no-reflow group included the STEMI patients who developed no-reflow after PCI.The control group included STEMI patients who achieved myocardial reperfusion after PCI.T-test,chi-square test,nonparametric rank sum test and logistic multivariate analysis were performed by using SPSS software.Baseline characteristics(sex,age,blood pressure,heart rate,LDL-C,TG,Killip level,cardiac ischemic time and history),PCI related characteristics(IRA,stent numbers,stent length and vessel diameter)and PCT values were recorded and compared between groups.Logistic multivariate analysis was performed to reveal the relevance of PCT value and no-reflow after PCI.ROC curve was plotted to evaluate the sensitivity of PCT value in the prediction of no-reflow.Subgroup analysis was performed according to patients?s age and cardiac ischemic time.Results1.When comparing the baseline information,the percentage of patients with Killip levels aboveⅡwas significantly higher in the no-flow group as compared with the control group(60.8%: 40.0%,p=0.037).Regarding other baseline characteristics,no significant difference was observed between groups.2.The levels of PCT(0.097±0.041:0.073±0.029,p=0.004)and NLR(8.92±4.77:6.32±3.71,p=0.010)in the no reflow group were significantly higher than the control group.Platelet numbers(158.35±39.20:198.82±68.60,p=0.009)was significantly lower in the no-flow group as compared with the control group.No significant differences was found between groups regarding other tests(p>0.05).3.By using logistic multivariate analysis,Killip level(OR=4.172,95% CI(1.188~14.65),p=0.026),platelet number(OR=0.984,95% CI(0.972~0.996),p=0.011)and NLR(OR=1.173,95% CI(1.018~1.351),p=0.028)may be used to predict the occurance of NRP.PCT level can not serve as an independent risk factor for the prediction of NRP(OR=1.017,95% CI(0.997~1.036),p=0.090).4.Subgroup Analysis1)In the subgroup of patients older than 65 years,there were no significant differences between groups when evaluating the level of PCT(0.079±0.037;0.085±0.029;p=0.662).And in the subgroup of patients younger than 65 years,the level of PCT(0.097±0.041;0.073±0.029,p=0.004)was significantly higher in the NRP group as compared with the control group.Logistic multivariate analysis indicated that PCT levels may serve as an independent predictor of NRP in patients performed PCI(OR=1.041,95% CI(1.006~1.077),p=0.021).2)Patients with longer myocardial ischemia time(≥180 mintues)had higher serum levels of PCT as compared with patients with shorter myocardial ischemia time(0.089±0.035;0.058±0.016,p=0.001).In patients with longer myocardial ischemia time(≥180 mintues),the level of PCT was significantly higher in the NRP group as compared with the control group(0.081±0.030;0.111±0.039;p=0.003).In patients with longer myocardial ischemia time(≥180 mintues),logistic multivariate analysis indicated that the level of PCT may serve as an independent risk factor for NRP(OR=1.021,95% CI(1.002~1.042),p=0.033).In patients with shorter myocardial ischemia time(<180 mintues),level of PCT can not serve as an independent risk factor for NRP(0.057±0.018;0.060±0.011;p=0.74).Conclusions1.The levels of PCT in STEMI patients who suffered from no reflow phenomenon were significantly higher than patients without no reflow phenomenon.However,PCT level can not be considered as an independent risk factor for the prediction of NRP after PCI.2.The levels of PCT were significantly higher in the patients with longer myocardial ischemia time(≥180 mintues)as compared with the patients suffering shorter myocardial ischemia time(<180 mintues).3.In younger STEMI patients(younger than 65y)or STEMI patients with longer myocardial ischemia time(≥180 mintues),serum PCT level may serve as an independent risk factor for NRP in patients performed PCI.