| Objectives: No-reflow phenomenon of IRA occurs after percutaneous coronary intervention(PCI)with acute ST segment elevation myocardial infarction(STEMI),resulting in a total loss of microcirculation in some areas and reversible injury.Despite improvement in revascularization strategies,no-reflow occurs during PCI with acute STEMI still represents an adverse outcome.How to accurately and rapidly identify the clinical predictors of no reflow is still need more research.It is beneficial to reduce the incidence of no-reflow by identifying high risk population through analyzing the clinical,angiographic and electrical factors associated with the no-reflow phenomenon.However,a fast-track and relatively simple screening tool is not available with STEMI undergoing PCI.The aim of this study was to access the high risk factors of the no-reflow phenomenon during PCI,to establish a bedside available risk scoring system of no-reflow at the acute stage of STEMI.Methods: Data from STEMI patients treated with PCI were collected from Jan 2010 to May 2016,and the patients were randomly divided into the model group and the validation group in a ratio of 3:1.Based on the standard of thrombolysis in myocardial infarction(TIMI)flow grade and TIMI myocardial perfusion grade(TMPG),patients were divided into no-reflow group and normal blood flow group.The no reflow phenomenon was defined as a final TIMI flow ?2 or final TIMI flow of 3 with TMPG<2.All clinical data and angiography findings of both groups were compared to analyze the risk factors related to no-reflow.Multivariable binary logistic regression analysis was used to identify independent no-reflow predictors of the model group,and then we designed a score according to the odds ratio on logistic regression analysis.In addition,we also did sub-group analysis of elderly patients and female patients.Results: The no-reflow phenomenon was found in 491(29.6%)of 1658 patients.Multivariate logistic regression analysis demonstrated that age?65,pulse pressure <50 mmHg,the ratio of neutrophil and lymphocyte>7,LP(a)<0.5 mmol/L,the value of ST elevation?0.4,pain to balloon time>6 hours,the grade of collateral circulation ?1 were independent predictors of no-reflow in the STEMI after PCI.The risk score system exhibited a good risk prediction in the model group with a c-statistic of 0.675 based on ROC analysis.Then we established a no-reflow scoring system with STEMI undergoing PCI according to the OR.Risk factors for risk assignment: age?65 counts as 2 points,pulse pressure <50 mm Hg counts as 2 points,the ratio of neutrophil and lymphocyte>7 counts as 2 points,LP(a)<0.5 mmol/L counts as 1 point,the value of ST elevation?0.4 counts as 2 points,pain to balloon time>6 hours counts as 1 point and the grade of collateral circulation ?1 counts as 2 points.Risk stratification: total value < 6 was ranked as low risk level,and 6-10 was ranked as the risk level,>10 as high risk level.The risk score system showed a good risk prediction in the validation group with a c-statistic of 0.660 based on ROC analysis.In elderly sub-group,the no-reflow phenomenon was found in 211(36.6%)of 576 patients.Multivariate logistic regression analysis demonstrated that age?85,preinfarction angina,smoking history,pulse pressure <50 mmHg,LP(a)<0.5 mmol/L,lead distribution of ST segment elevation?4 were independent predictors of no-reflow phenomenon in the STEMI after PCI.The risk score system demonstrated a good risk prediction in the model group with a c-statistic of 0.702 based on ROC analysis.Then we established a no-reflow scoring system with STEMI undergoing PCI according to the OR.Risk factors for risk assignment: age?80 counts as 2 points,preinfarction angina counts as 2 points,smoking history counts as 2 points,pulse pressure <50 mmHg counts as 2 points,LP(a)<0.5 mmol/L counts as 2 points and lead distribution of ST segment elevation?4 counts as 3 points.Risk stratification: total value < 5 was ranked as low risk level,and 5-8 was ranked as the risk level,>8 as high risk level.The risk score system demonstrated a good risk prediction in the validation group with a c-statistic of 0.566 based on ROC analysis.In female sub-group,the no-reflow phenomenon was found in 109(28.8%)of 379 patients.Multivariate logistic regression analysis demonstrated that the percentage of neutrophils?80,Glu>8 mmol/L,EF<50,the use of beta-blockers,post ballooning,the extent of calcification of culprit coronary artery lesions?2 were independent predictors of no-reflow phenomenon in the STEMI after PCI.The risk score system demonstrated a good risk prediction in the model group with a c-statistic of 0.747 based on ROC analysis.Then we established a no-reflow scoring system with STEMI undergoing PCI according to the OR.Risk factors for risk assignment: the percentage of neutrophils?80 counts as 3 points,Glu>8 mmol/L counts as 2 points,EF<50 counts as 3 points,the use of beta-blockers counts as 2 points,post ballooning counts as 2 points and the extent of calcification of culprit coronary artery lesions?2 counts as 3 points.Risk stratification: total value < 5 was ranked as low risk level,and 5-8 was ranked as the risk level,>8 as high risk level.The risk score system demonstrated a good risk prediction in the validation group with a c-statistic of 0.662 based on ROC analysis.Conclusions: 1 Age?65,pulse pressure <50 mmHg,the ratio of neutrophil and lymphocyte>7,LP(a)<0.5 mmol/L,the value of ST elevation?0.4,pain to balloon time>6 hours,the grade of collateral circulation ?1 were independent predictive factors of no reflow in patients with STEMI undergoing PCI.Age?80,preinfarction angina,smoking history,pulse pressure <50 mmHg,LP(a)<0.5 mmol/L,the lead distribution of ST segment elevation?4 were independent correlate predictors of no-reflow phenomenon in the elderly patients with STEMI after PCI.The percentage of neutrophils?80,Glu>8 mmol/L,EF<50,the use of beta-blockers,post ballooning,the extent of calcification of culprit coronary artery lesions?2 were independent correlate predictors of no-reflow phenomenon in the female patients with STEMI after PCI 2 The grade of collateral circulation ?1,the lead distribution of ST segment elevation?4,and EF<50 were the strongest predictor of no reflow in patients with STEMI undergoing PCI of general population,elderly subgroup,and female subgroup,respectively.3 Risk score system was helpful to identify high risk patients with STEMI undergoing PCI. |
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