Correlation Between Platelet Factors As Well As Hs-CRP And No-reflow In Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objective:To explore the significance of platelet factors and hs-CRPlevels in predicting the no-reflow phenomenon in patients with ST-segmentelevation myocardial infarction (STMEI) undergoing primary percutaneouscoronary intervention by measuring the levels of PLT, PDW, MPV, Fib andhs-CRP.Methods:A total of112(93males and19females) STEMI patientsundergoing primary percutaneous coronary intervention were enrolled in thisstudy from January2012to March2013,in the second hospital of HebeiMedical University. According to the occurrence of no-reflow, all patientswere divided into No-reflow group and Normal flow group. There were35cases(28males and7females) in No-reflow group with lower myocardialperfusion levels (TMPG0-2),the mean age was63.76±10.40(range37-81year);and there were77cases(65males and12females) in Normal flow groupwith normal myocardial perfusion level(TMPG3),the mean age was58.98±11.59(range37-85year). The platelet count, mean platelet volume,platelet distribution width, fibrinogen and hypersensitive c-reactive proteinlevels were compared between the two groups and the correlation withno-reflow in patients with ST-segment elevation myocardial infarctionundergoing primary percutaneous coronary intervention.All patients have not taken aspirin that affect platelet activitypreoperatively. The18leads electrocardiogram, blood pressure, blood routinetest, coagulation routine test, renal function, hepatic function, plasma lipid, blood glucose, platelet aggregation rate,myocardial enzyme and hypersensitivec-reactive protein were checked before reperfusion therapy. All the data were analyzed with SPSS19.0software. A value of P<0.05(2-sided) wasconsidered statistically significant.Results:1.There was no significant difference between No-reflow group andNormal flow group in baseline clinical characteristics(P＞0.05),including thegender, BMI, hemochrome，history of hypertension, hyperlipidaemia anddiabetes mellitus, smoking history, plasma lipid (including total cholesteroland triglycerides), hemodynamic data (including heart rate, systolic pressureand diastolic pressure). But the age of No-reflow group was elder(63.76±10.40years vs58.75±11.19years, P＜0.05) and symptomonset-reflow time was longer (9.40±3.10h vs7.39±3.30h, P＜0.05) than thatof Normal flow group, the level of blood sugar of No-reflow group washigher(10.12±1.87mmol/L vs9.40±1.68mmol/L, P＜0.05) than that ofNormal flow group, CK (1324.61±313.06vs1108.46±326.02U/L, P＜0.05)and CKMB (99.61±12.09U/L vs91.50±12.01U/L)of No-reflow group werebigger than that of Normal flow group.2.Angiographic features of the study patients: there was no significantdifference between the two groups in the proportion of the left anteriordescending artery, left circumflex artery and right coronary artery respectively(P＞0.05). Also, the differences in the degree of coronary artery stenosis,reference lumen diameter and lesion extent between the two groups were notstatistically significant(P＞0.05). But the times of balloon dilatation ofNo-reflow group was more than that of Normal flow group(2.41±0.88vs2.07±0.82, P＜0.05).3.Comparision of platelet and inflammatory factors levels betweengroups: results shown, the PDW level of No-reflow group was higher than thatof Normal flow group(16.76±2.17%vs15.06±1.89%, P＜0.05); the MPVlevel of No-reflow group was higher than that of Normal flow group(11.83±1.22fl vs10.16±1.21fl, P＜0.05); and the hs-CRP level of No-reflowgroup was higher than that of Normal flow group(30.87±8.84mg/L vs23.45±9.74mg/L, P＜0.05); there was no significant difference between No-reflow group and Normal flow group in PLT and Fib Level(P＞0.05).4.Correlation analysis: Univariable logistic regression analyses showedthat the age, the level of blood sugar, symptom onset-reflow time, MPV, PDWand hs-CRP were the influence factors of no-reflow in STEMI patientsundergoing primary percutaneous coronary intervention. Multivariable logisticregression analyses showed that only symptom onset-reflow time(P=0.020,OR=1.47), PDW(P=0.011,OR=1.70), MPV (P=0.000,OR=5.93) andhs-CRP (P=0.018,OR=1.10) were the independent predictors of no-reflow.Conclusions:Platelet factors MPV and PDW, inflammatory factor hs-CRP were theindependent predictors of no-reflow in patients with ST-segment elevationmyocardial infarction undergoing primary percutaneous coronary intervention.