Correlation Between Red Cell Distribution Width To Platelet Ratio And No-Reflow Phenomenon In Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objective: This study is designed to explore the significance of red cell distribution width to platelet ratio levels in predicting the no-reflow phenomenon in patients with ST-segment elevation myocardial infarction(STMEI)undergoing primary percutaneous coronary intervention by measuring the results of some laboratory tests.Methods: Methods: In this test,patients who were diagnosed with STEMI receiving primary PCI in the First Hospital of Xingtai City from September 2013 to December 2015 were enrolled.Inclusion criteria:(1)The diagnostic criteria of STEMI proposed by CSC in 2015;(2)Patients were administered in 12 hours from onset of chest pain;(3)Patients underwent primary PCI;(4)family members have signed PCI informed consent.Exclusion criteria:(1)Allergic to anisodamine,anesthetic or contrast medium;(2)Severe hepatic insufficiency(transaminase is greater than 2 folds of the normal upper limit);(3)Severe renal insufficiency required dialysis treatment;(4)Aortic Dissection;(5)History of PCI/CABG operation;(6)Malignant arrhythmia;(7)Cardiac shock equired intra-aortic balloon pump(IABP)support;(8)Anticoagulant or antiplatelet contraindication;(9)The presence of autoimmune diseases,severe trauma,bleeding disorders and tumors;(9)Having received thrombolysis;(11)Patients refuse to sign the informed consent.All subjects were well prepared with oxygen,electrocardiogram(ECG)monitoring,sedation medication as well as adequate anticoagulation and antithrombotic treatment.All patients enrolled were required to perform CAG and PCI in cardiology department.During the operation,characteristic like the time from symptom onset to balloon dilatation,TIMI flow grade before and after PCI procedure,corrected TIMI frame count(CTFC),TIMI myocardial perfusion grade(TMPG)were recorded.Eligible patients were assigned to A group(No-Reflow group)or B group(normal group)according to TMPG grade.Both group received the same basic medical treatment,including anticoagulant or antiplatelet meidicine,ACEI/ARB,CCB,beta-blocker,statins,nitrates and other routine medication.The baseline clinical characteristics,laboratory like blood routine test,D-dimer,hs-CRP,CK-MB,cTnI,glucose,LDL-C,BNP et al.Left ventricular ejection fraction(LVEF)was calculated in admission and 30 days after operation.The incidence of major adverse cardiac events(MACEs)between two groups was followed in 30 days.All clinical data were analyzed with SPSS 20.0.P Value of less than 0.05(2-tailed)was considered to be statistically significant.Results: Among 80 cases in this study,27 cases were assigned to A group(20 male,average age 64.39±11.87 years old)and 53 cases to B group(43male,average age 57.84±12.44 years old).1 Comparison about baseline clinical characteristics.There were no significant differences between both groups in baseline characteristics,including gender distribution,risk factors(hypertension,hyperlipidermia,smoking history),family history,body mass index(BMI)and CRUSADE score(All P>0.05).The average age of A group is 64.39±11.87 years old,the average age of B group is 57.84±12.44 years old,the difference between two groups is significant(P<0.001);In A group,there were 10 patients has obvious CHD history,and in B group there were 33(P=0.032);Difference of TIMI score and GRACE score were also statistical(10.65±2.98 vs.8.37±3.18,P=0.027;144.56±34.78 vs.129.48±30.56,P=0.037).2 Angiographic and procedural characteristicsThe delaying time from onset of chest pain to balloon dilatation in A group is 6.4±2.1h,in B group is 5.1±2.3h(P=0.018).During PCI procedure,CAG showed there were no statistical differences between two groups in the proportion of ischemic-related artery,the average length and diameter of stents,the percentage of TIMI grade 3 before PCI.The CTFC of LAD,LCX and RCA in A group was more than those in B group(25.29±5.59 vs.19.81±6.00,P=0.0002;23.50±6.53 vs.18.86±6.67,P=0.004;24.00±6.00 vs.19.88±3.72,P= 0.0003).The percentage of pre-dilatation in A group is more than B group(P< 0.001).There was no difference between two groups in the percentage of post-dilatation,thrombus aspiration,usage of Tirofiban and dilatation pressure(9.7% vs.12.9%,P>0.05).3 Laboratory tests resultsThere existed no statistical difference in RBC,PLT,Scr,cTnI,CK-MB,LDL-C?glucose value between both groups at admission(All P>0.05).The value of WBC in A group is higher than B group without statistical significance(P=0.067).The difference between A and B of NE(%)is obvious(78.30±14.38 vs.67.44±14.73,P=0.002).There is statistical difference in RDW between two groups(6.68±1.19 vs.5.38±1.45,P< 0.001);eGFR of A group is lower than B group(89.08±12.22 vs.103.94±18.91,P<0.001);so was hs-BNP value(8.58±1.98 vs.5.11±1.27,P<0.001),BNP levels(254.80±87.70 vs.216.03±72.18,P=0.038)and D-dimer(0.79±0.40 vs.0.60±0.38,P=0.041).4 Evaluation of heart function.There was significant difference between two groups about LVEF when patients admitted(44.29±4.14 vs.47.55±3.67,P=0.006);30 days after PCI,LVEF levels were elevated between two groups as well as in each own group(45.29±4.14 vs.45.55±3.67,P=0.796;47.37±3.91 vs.46.93±2.71,P=0.858;48.87±4.30 vs.47.63±3.46,P=0.298).After 30 days of PCI,LVEF improved within each group(44.29±4.14 vs.47.87±8.30,P<0.05;47.55±3.67 vs.51.63±4.99,P<0.05;47.87±8.3 vs.51.63±4.99,P=0.002).5 MACEs in follow-upIn the follow-up visit,4 patients in A group and 1 patient suffered from cardiac death,6 patients in A group and 1 patient suffered from malignant arrhythmia,14 patients in A group and 8 patient suffered from heart failure,2 patients in A group suffered from remyocardial infarction,1 patients in A group received vessel reconstruction;4 patients in A group and 2 in B group were rehospitalized because of cardiac reasons in 30 days.Significant difference was found between two groups concerning the incidence of MACEs(P<0.05).6 Logistic multivariate analysisIn the binary logistic multivariate analysis,considering factors like time from onset to dilatation,previous CHD history,NE(%),hs-CRP,RDW and RPR,RPR(OR = 2.104,95%CI = 1.343-3.297,P = 0.001)was an important independent risk factor for NR in patients with STEMI receiving primary PCI.Conclusion:1 For patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention,risk factors including ages,diabetes history,previous CHD,delaying reopening IRA,NE,RDW,RPR,hs-CRP,eGFR and BNP were predictive elements of no-reflow phenomenon;2 Red cell distribution width to platelet ratio was the independent predictors of no-reflow phenomenon in patients with STEMI undergoing primary PCI,deserving clinical physicians' attention.