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This study aimed to evaluate the association of admission PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy (PRECISE-DAPT) score with the development of no-reflow (NR) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). In this observational, retrospective study, 335 consecutive STEMI patients who were treated with primary PCI were included. We classified the study population into 2 groups: patients with a PRECISE-DAPT score <25 and those with a PRECISE-DAPT score ≥25. Overall, 30 (8.9%) patients developed NR. The mean PRECISE-DAPT score (20.03 ± 15.32 vs 11.33 ± 12.18; P =.005) was significantly higher in cases who developed NR. Moreover, arrhythmic complications, in-hospital shock, and in-hospital mortality rates were significantly higher in patients with a PRECISE-DAPT score ≥25 compared to those with a PRECISE-DAPT score <25. According to a multivariable analysis, the PRECISE-DAPT score was found to be independently linked with NR (odds ratio: 2.87, with P =.015). To our knowledge, these data are the first in major medical science databases to determine the relationship between the PRECISE-DAPT score and the NR phenomenon in patients with STEMI undergoing primary PCI. [ABSTRACT FROM AUTHOR]

Background and Aims: Morphine use for patients presenting with NSTE-ACS is associated with excess mortality. However, the role of morphine in STE-ACS is ill characterized. We have recently confirmed direct prothrombotic effect of morphine using murine models. We sought to explore whether morphine use in STE-ACS patients, used to be scheduled for downstream P2Y12 blockers, is negatively associated with procedural and clinical outcomes. Methods: A single-center, observational retrospective analysis enrolling 130 non-randomized stable patients sustaining STE-ACS as their first manifestation of coronary disease, who presented between December 2010 and June 2013. All were managed by early invasive approach. Of study patients, 55 were treated by morphine, and 75 were not. All were administered downstream P2Y12 blockers according to an already abandoned local policy. Outcomes evaluated included TIMI grade flow, thrombus burden, ST-segment resolution, myocardial function by echocardiography, and cardiovascular death. Results: Morphine administration was associated with a significantly higher incidence of impaired final TIMI grade flow (TIMI < 3, 40% vs 4%, P <.05), lower incidence of ST-segment resolution >70% (40.7% vs 76.5%, P <.05), and a higher incidence of moderate or severe systolic dysfunction (48.1% vs 29.1%, P <.05) compared with morphine naive patients. Interestingly, the overall mortality rate was higher in the morphine-treated group (18% vs 5.3%, P <.05). Conclusions and Relevance: Morphine administration combined with the downstream P2Y12 blockers practice signify a group with a higher occurrence of impaired myocardial reperfusion and cardiovascular death despite established on-time primary angioplasty. [ABSTRACT FROM AUTHOR]

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Coronary no-reflow damage is caused by endothelial cell damage although little drug is available to intervene in coronary no-reflow. Liraglutide is a kind of anti-diabetic drug and its cardioprotective role has been widely reported. In this study, we explored the role of liraglutide in regulating coronary endothelial cell damage. We used hydrogen peroxide to mimic coronary no-reflow damage in vitro. After exposure to hydrogen peroxide, endothelial cells' viability was significantly reduced, an effect that was followed by an increase in cell apoptosis. Interestingly, liraglutide treatment obviously upregulated endothelial cell viability and thus prevented cell apoptosis. Further, we also found that liraglutide inhibited the activation of caspase-3 in hydrogen peroxide-treated endothelial cells. Besides, cellular metabolism, as reflected by mitochondrial membrane potential, was disrupted by hydrogen peroxide and reversed to normal levels with liraglutide. Further, we found that the ERK pathway is a potential downstream effector of liraglutide. Administration of liraglutide significantly promoted the activation of ERK and this effect may contribute to endothelial cell survival. Altogether, our results illustrated that hydrogen peroxide-mediated endothelial cell damage could be attenuated by liraglutide through modulation of the MAPK/ERK signaling pathway. This finding will pave a novel road for the intervention of coronary no-reflow damage in patients suffering from myocardial infarction. [ABSTRACT FROM AUTHOR]

The ‘no-reflow’ phenomenon (NRP) after primary percutaneous coronary intervention (PCI) is a serious complication among acute ST-segment elevation myocardial infarction (STEMI) patients. Herein, a comprehensive lipidomics approach was used to quantify over 300 distinct molecular species in circulating plasma from 126 patients with STEMI before and after primary PCI. Our analysis showed that three lipid classes: phosphatidylcholine (PC), alkylphosphatidylcholine (PC(O)), and sphingomyelin (SM), were significantly elevated (p < 0.05) in no-reflow patients before primary PCI. The levels of individual fatty acids and total fatty acid levels were significantly lower (p < 0.05) in no-reflow subjects after PCI. The grouping of patients based on ECG ST-segment resolution (STR) also demonstrated the same trend, confirming the possible role of these differential lipids in the setting of no-reflow. Sphingomyelin species, SM 41:1 and SM 41:2, was invariably positively correlated with corrected TIMI frame count (CTFC) at pre-PCI and post-PCI. The plasma levels of SM 42:1 exhibited an inverse association (p < 0.05) consistently with tumor necrosis factor-alpha (TNF-α) at pre-PCI and post-PCI. In conclusion, we identified plasma lipid profiles that distinguish individuals at risk of no-reflow and provided novel insights into how dyslipidemia may contribute to NRP after primary PCI.

Background: No-reflow is considered a major percutaneous coronary intervention complication, especially in primary PCI. A variety of medications have been studied for no-reflow treatment, including intracoronary nitrates, verapamil, adenosine, glycoprotein IIb/IIIa inhibitors, and epinephrine. Glycoprotein IIb/IIIa inhibitors and epinephrine are the two most promising agents for the treatment of no-reflow. Aim of work: evaluating epinephrine and glycoprotein IIb/IIIa inhibitors efficacy in treating no-reflow through local distal intracoronary injection in comparison to traditional intracoronary administration in the guiding catheter. Subjects and methods: 30 patients undergoing PCI complicated by no-reflow phenomenon. Patients were randomized to either group I where they were treated by local distal intracoronary injection of GP IIb/IIIa inhibitor and epinephrine or to group II where they received the same medications via the traditional intracoronary injection. Primary outcomes were TIMI flow, corrected TIMI frame count and TMPG, and major adverse cardiac events within 48 hours was the secondary outcome. Results: Group I had significantly superior angiographic outcomes than group II. As regards TIMI II-III flow, 86.7% of patients achieved it in versus 53.3% in group II, CTFC was 8.2versus 9.9, and in group I, 80% of patients achieved TMPG II-III, compared to 46.7 % in group II. MACE was insignificantly different between both groups. Diabetes mellitus was found to be the only predictor to be negatively associated with TIMI flow. Conclusion: Distal coronary artery local injection of a combination of GP IIb/IIIa inhibitors and epinephrine achieved superior angiographic outcomes in the treatment of refractory no-reflow in comparison with traditional intracoronary administration of the same medications. [ABSTRACT FROM AUTHOR]

Background: Acute myocardial infarction is a leading cause of morbidity and mortality worldwide. It occurs when irreversible myocardial cell damage or death occurs. ST‐segment elevation myocardial infarction (STEMI) is the most serious presentation of atherosclerotic coronary artery disease. STEMI results from the occlusion of a major coronary artery. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy. It should be performed by an experienced team within the shortest time possible from the first medical contact. Hypothesis: Increased mortality risk and no‐reflow in STEMI patients with epicardial adipose tissue thickness (EAT) more than 5 mm compared to STEMI patients with EAT less than 5 mm. Methods: This study was conducted on 113 patients who presented to the cardiology department of Ain Shams university hospital with the first STEMI and underwent primary PCI. Medical treatment for STEMI was given to all subjects as per the guidelines. All patients underwent an echocardiographic evaluation of epicardial adipose tissue and left ventricular ejection fraction. Patients were divided into two groups using epicardial adipose tissue thickness of 5 mm as a cutoff point; this number was derived from the ROC curve. Group I: Included patients with EAT thickness less than 5 mm, including 44 patients (38.9%). Group II: Included patients with EAT thickness greater than 5 mm, including 69 patients (61.1%). Results: The current study showed that epicardial fat thickness significantly correlated with the no‐reflow phenomenon in the cath lab and overall prognosis in patients with STEMI. Conclusion: Increased EAT thickness may be an independent predictor of the no‐reflow phenomenon and mortality. Therefore, our study emphasizes that EAT thickness measured by echocardiography may provide additional and substantial information on the risk of no‐reflow and mortality in STEMI patients. [ABSTRACT FROM AUTHOR]

Background: Deferred stenting, despite being successful in early studies, showed no benefit in recent trials. However, these trials were testing routine deferral; not in patients with heavy thrombus burden. Results: This is a prospective, Randomized Clinical Trial that included 150 patients who presented with STEMI, patients were allocated into three equal groups after the coronary angiography ± primary intervention and before stenting of the culprit lesion; group (A) included 50 patients with early deferral of stenting, group (B) included 50 patients with late deferral and group (C) included 50 patients with immediate stenting. No-reflow was significantly higher in group C, while Final TIMI flow grade 3 and MBG grade 3 were significantly higher in group A and B than group C; p = 0.019 and < 0.001 respectively, with no significant difference between groups A and B, only the thrombus resolution in group B was significantly higher than group A; p < 0.001. Finally, 6-months, over-all MACE was significantly higher in group C (34.7% vs. 14.6% and 16.3%, p = 0.029). Conclusions: Stent deferral was proved to be better than immediate stenting after recanalization of IRA, in achieving TIMI III flow, reducing risk of 6 months MACE, and restoration of myocardial function in a subset of STEMI patients presenting with large thrombus burden. While, no significant difference was found between both deferral times in final TIMI flow, or clinical outcomes. [ABSTRACT FROM AUTHOR]

Saphenous vein grafts (SVGs) remain the most frequently used conduits in coronary artery bypass graft surgery (CABG). Despite advances in surgical techniques and pharmacotherapy, SVG failure rates remain high, often leading to repeat coronary revascularization. The no-touch SVG harvesting technique (minimal graft manipulation with preservation of vasa vasorum and nerves) reduces the risk of SVG failure, whereas the effect of the off-pump technique on SVG patency remains unclear. Use of buffered storage solutions, intraoperative graft flow measurement, careful selection of the target vessels, and physiological assessment of the native coronary circulation before CABG may also reduce the incidence of SVG failure. Perioperative aspirin and high-intensity statin administration are the cornerstones of secondary prevention after CABG. Dual antiplatelet therapy is recommended for off-pump CABG and in patients with a recent acute coronary syndrome. Intermediate (30%-60%) SVG stenoses often progress rapidly. Stenting of intermediate SVG stenoses failed to improve outcomes; hence, treatment focuses on strict control of coronary artery disease risk factors. Redo CABG is associated with higher perioperative mortality compared with percutaneous coronary intervention (PCI); hence, the latter is preferred for most patients requiring repeat revascularization after CABG. SVG PCI is limited by high rates of no-reflow and a high incidence of restenosis during follow-up. Drug-eluting and bare metal stents provide similar long-term outcomes in SVG PCI. Embolic protection devices reduce no-reflow and should be used when feasible. PCI of the corresponding native coronary artery is associated with better short- and long-term outcomes and is preferred over SVG PCI, if technically feasible. [ABSTRACT FROM AUTHOR]

Despite routinely restoring epicardial coronary patency, with primary percutaneous coronary intervention (PCI), microvascular obstruction affects approximately half of patients and confers an adverse prognosis. There are no evidence-based treatments for microvascular obstruction. A key contributor to microvascular obstruction is distal embolisation and microvascular thrombi. Adjunctive intracoronary fibrinolytic therapy may reduce thrombotic burden, potentially reducing distal embolisation of atherothrombotic debris to the microcirculation. In this review, the evidence from published randomised trials on the effects of adjunctive intracoronary fibrinolytic therapy during primary PCI is critically appraised, the ongoing randomised trials are described, and conclusions are made from the available evidence. Clinical uncertainties, to be addressed by future research, are highlighted. [ABSTRACT FROM AUTHOR]

In this review article we tried to find an answer to the question, should local coronary hypothermia be a part of the early reperfusion strategy in patients with STEMI to prevent reperfusion injury, no-reflow phenomenon, and to reduce the infarct size and mortality. Hypothermia can save cardiomyocytes if achieved in a timely fashion before reperfusion. Intracoronary hypothermia can be adjunct to PCI by lessening ischemia/reperfusion injury on cardiomyocytes and reduction in infarct size. Reperfusion induced Calcium overload, generation of ROS and subsequent activation of Mitochondrial permeability transition pore (MPT) are major contributors to reperfusion injury. Hypothermia reduces calcium loading of the cell and maintains cellular energy and tissue level glucose which can scavenger ROS. Hypothermia reduces MPT activation and thus reduces infarct size. Systemic cooling trials failed to reduce infarct size, perhaps because the target temperature was not reached fast enough, and it was associated with systemic side effects. The need for rapid induction of hypothermia to <35 °C with the ethical concern of delaying reperfusion while cooling the patient and the inconsistency of endovascular cooling results lead to a belief that endovascular cooling may exceed the acceptable level of invasiveness in the context of other novels cardioprotective, regenerative and reperfusion therapies. Clinical trials showed the safety and feasibility of novel intracoronary hypothermia with rapid induction and maintenance of hypothermia using routine PCI equipment ahead of reperfusion. Two phases of cooling were applied without significant delay in the door to balloon time. Cooling of the coronary artery leads to cooling of its dependant myocardium without affecting adjacent myocardium. Heat transfer occurred by heat conduction during the occlusion phase and heat convention during the reperfusion phase. Fine-tuning of saline temperature and infusion rate helped to improve the protocol. The best duration of hypothermia before and after reperfusion is not known and needs further investigation. A balance between the undoubted cardioprotective effects of hypothermia with iatrogenic prolongation of ischemia time needs to be established. A reduction in infarct size was observed but needs to be validated with large randomized trials. Furthermore, it might be possible to augment the cardioprotective effects of intracoronary hypothermia by combination with other cardioprotective approaches such as antioxidant drugs and afterload reducing agents. [ABSTRACT FROM AUTHOR]

It remains uncertain whether plasma D-dimer level can predict no-reflow in patients with STEMI who had pPCI after 48 h of symptom onset. This study retrospectively enrolled 229 consecutive patients who had pPCI for acute STEMI within 2–7 days of symptom onset between January 2008 and December 2018. Patients were divided into no-reflow group (TIMI flow grade 0–2) and reflow group (TIMI flow grade 3). Predictors of no-reflow were assessed by univariate and multivariate binary logistic regression analyses. Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2–7 days of symptom onset (OR 2.52 per 1 mg/L increase, 95% CI 1.16–5.47, p = 0.019). This finding indicated that pPCI may be safe and feasible for STEMI patients within 2–7 days of symptom onset with low D-dimer level. [ABSTRACT FROM AUTHOR]

Background: regardless of the magnitude of the infarction, no-reflow is a source of numerous problems, including heart failure, stroke, and death. The CHA2DS2-VASc score is a combination of many risk variables for thromboembolic lesions, the most serious consequences of atrial fibrillation. Current guidelines propose using the CHA2DS2-VASc risk score to estimate thromboembolic events in individuals with atrial fibrillation. It has been demonstrated to be a predictor of problems following acute coronary crises. Aim of the Work: to assess the role of CHA2DS2-VASc score in prediction of the no-reflow among patients with ST-segment elevation myocardial infarction (STEMI) who was treated with primary PCI. Subjects and Methods: this is a prospective observational study which was done at cardiology department of Ain Shams University on 300 patients. Results: the most frequent factor was female sex (43.7%), followed by Diabetes mellitus (27.0%) according to CHA2DS2-VASc score. CHA2DS2-VASc score items statistically were significantly more frequent in no reflow cases except Age ≥75. CHA2DS2-VASc score and its modification significantly had low diagnostic performance in predicting no reflow. Modified was higher than original. Conclusion: all CHA2DS2-VASC items were proved to be factors affecting no reflow occurrence in the Egyptian population except Age ≥75 and congestive heart failure due to their low prevalence. The CHA2DS2-VASC score had no high diagnostic characteristics in Egyptian population, the postulated modification of CHA2DS2-VASC score gave no better diagnostic characteristics. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the relationship between no-reflow (no-RF), reflow (RF), and the P-wave time index in patients undergoing percutaneous coronary intervention (PCI) with a diagnosis of acute myocardial infarction (AMI) due to total occlusion. Methods: This study included a total of 272 AMI patients with no-RF (110 patients) and RF (162 patients). Results: The no-RF group had higher values of mean maxPWTpostPCI(94.95 ± 15.61 vs. 117.86 ± 12.06, P < 0.001), minPWTpostPCI(54.21 ± 12.13 vs. 67.31 ± 11.79, P < 0.001), and PWDpostPCI(39.14 ± 12.55 vs. 50.91 ± 11.9, P < 0.001) during the post-PCI period. According to multivariate logistic regression analysis, maxPWTpostPCI(odds ratio [OR]: 1.103, 95% confidence interval [CI]: 1.049–1.160, P < 0.001), minPWTpostPCI(OR: 1.055, 95% CI: 1.011–1.101, P = 0.0014), and PWDpostPCI(OR: 1.107, 95% CI: 1.037–1.181, P = 0.002) were the independent predictors of RF after PCI. ROC curve analyses demonstrated that the optimal cutoff values for maxPWTpostPCI, minPWTpostPCI, and PWDpostPCIfor predicting no-RF were 112.95 ms (area under the curve [AUC]: 0.852, 95% CI: 0.807–0.898, P < 0.001, sensitivity 70%, specificity 85.2%), 62.66 ms (AUC: 0.650, 95% CI: 0.585–0.716, P < 0.001, sensitivity 54.5%, specificity 72.8%), and 43.43 ms (AUC: 0.782, 95% CI: 0.727–0.837, P < 0.001, sensitivity 75.5%, specificity 60.5%), respectively. Conclusions: Prolonged maxPWTpostPCI, maxPWTpostPCI,and PWDpostPCIare independent predictors that differentiate no-RF from RF in patients with AMI after PCI and can be used in the follow-up of no-RF patients during the post-PCI period.

Recently, there has been a positive trend to reduce mortality from myocardial infarction. One of the reasons for such dynamics is the development of angiographic service in our country and the increase in the number of primary percutaneous coronary interventions. One of the most serious complications of endovascular interventions affecting the prognosis is the development of the phenomenon of slow or unrecoverable blood flow (≪slow/no-reflow≫ phenomenon). The reason for the development of this phenomenon is associated, first of all, with distal embolization by thrombotic masses and fragments of atherosclerotic plaque. In order to prevent this complication, manual thromboextraction was developed – the aspiration of thrombotic masses from the infarct-related artery. The manual thrombus aspiration has not been proven effective in a number of large randomized trials. In addition to the lack of influence on the prognosis, the method of manual thrombus aspiration significantly more often led to the development of ischemic strokes and currently should not be routinely carried out. Another method of preventing the phenomenon of delayed or unrecoverable blood flow is the use of glycoprotein IIb/IIIa receptor inhibitors which is, in contrast to the instrumental method, effective and relatively safe. According to a number of large randomized trials, drug treatment of this complication influences life expectancy in patients with ST-elevation myocardial infarction. At a time when there is already a meta-analysis on the routine use of glycoprotein IIb/IIIa receptor inhibitors during primary percutaneous coronary intervention and their positive impact on survival, in our country, unfortunately, the importance of these drugs is underestimated and according to the register they are used only in 3% of patients with ST-segment elevation myocardial infarction. This review presents studies and comparisons of glycoprotein IIb/IIIa receptor inhibitors existing on the market.

Objective To investigate the predictive value of D-dimer combined with activated partial thromboplastin time (APTT) for slow/no-reflow of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome(ACS). Methods A total of 181 ACS patients undergoing emergency PCI in our department from November 2015 to June 2018 were recruited in this study. Their plasma D-dimer level and APTT were tested before surgery. According to thrombolysis in myocardial infarction (TIMI), the patients were divided into slow/no-reflow group and normal blood flow group. The correlations of D-dimer level and APTT were analyzed with the incidence of slow/no-reflow. According to the cutoff values of the 2 indicators, the patients were assigned into high-risk group and non-high-risk group, and the incidence of slow/no-reflow was compared between the 2 groups. Results Logistics multivariate regression analysis showed preoperative D-dimer (OR=2.801, 95% CI=1.399~5.610, P=0.004) was positively, and APTT (OR=0.881, 95%CI=0.810~0.959, P=0.003) was negatively correlated with slow/no-reflow phenomenon. According to ROC curve, D-dimer AUC=0.612 (95% CI=0.537~0.683, P=0.036), APTT AUC=0.653 (95% CI=0.579~0.722, P=0.004), and AUC increased to 0.697 (95% CI=0.624~0.763, P < 0.001) when D-dimer was combined with APTT index. According to the cutoff values of D-dimer and APTT, the incidence of slow/no-reflow in high-risk and non-high-risk groups was 36.17% and 14.92%, respectively (P=0.002). Conclusion Higher preoperative D-dimer indicates higher incidence of slow/no-reflow in ACS patients after emergency PCI, while preoperative APTT is negatively correlated with the incidence. So combined detection of the 2 indicators helps predict the occurrence of slow/no-reflow in the patients.

Introduction: No-reflow increases the complications and mortality rate of primary percutaneous coronary intervention (PCI). Therefore, it is important to identify patients at a higher risk of developing no-reflow. This study aimed to systematically review the prognostic value of the platelet-to-lymphocyte ratio (PLR) to predict no-reflow. Materials and Methods: The databases, such as Pubmed, EMBASE, and Web of Knowledge were searched for the relevant studies. Two authors independently performed data extraction and quality assessment of the included studies. In this meta-analysis, sensitivity and specificity of PLR, as well as the pooled odds ratio were calculated to predict no-reflow and compared with the pooled means of PLR in no-reflow and reflow groups. Results: According to the results obtained from six out of eight studies in this systematic review, there was a significant association between PLR and no-reflow. Moreover, a pooled six-fold increase of no-reflow risk was observed in the high PLR group. Pooled sensitivity and specificity of PLR to predict no-reflow was 65% (CI95%: 61%-69%) and 77% (CI95%: 76%-79%), respectively. The mean pooled of PLR in the no-reflow group was significantly 65.2 (CI95%: 26.7-103.8) units higher than that in the reflow group. Conclusions: The PLR is a significant predictor of no-reflow in STEMI patients subjected to primary PCI which can be used alone or in combination with other markers to identify patients at higher risk of developing no-reflow.

Objective: The benefit of intracoronary thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) is not yet fully clear. The aim of this study was to investigate the clinical impact of visible thrombus aspiration (VTA) material. Methods: A total of 295 patients with a Thrombolysis in Myocardial Infarction (TIMI) flow score of 0 or 1 after an anterior STEMI were included in the study. Manual TA devices were used before performing PCI. The patients were divided into 2 groups: (1) visible thrombus aspiration (VTA) group and (2) non-visible thrombus aspiration (non-VTA) group. No-reflow was defined as TIMI grade 0, 1, or 2 flow, or TIMI grade 3 with a myocardial blush of grade 0 or 1. The primary endpoint was the occurrence of no-reflow. Results: VTA was retrieved in 178 (60.3%) of the patients. A no-reflow determination was significantly less frequent in the VTA group (p

Background: The coronary atherosclerotic burden in patients with ST-segment elevation myocardial infarction (STEMI) has been identified as the main predictor of prognosis. However, the association of lipoprotein(a) [Lp(a)], a well-established proatherogenic factor, with atherosclerotic burden in patients with STEMI is unclear.Methods: In total, 1,359 patients who underwent percutaneous coronary intervention (PCI) for STEMI were included in analyses. Three prespecified models with adjustment for demographic parameters and risk factors were evaluated. Generalized additive models and restricted cubic spline analyses were used to assess the relationships of Lp(a) with Gensini scores and the no-reflow phenomenon. Kaplan–Meier curves were generated to explore the predictive value of Lp(a) for long-term all-cause mortality. Furthermore, mRNA expression levels of LPA in different groups were compared using the GEO database.Results: Patients in the highest tertile according to Lp(a) levels had an increased incidence of heart failure during hospitalization. Furthermore, patients with high levels of Lp(a) (>19.1 mg/dL) had sharply increased risks for a higher Gensini score (Pfor trend = 0.03) and no-reflow (Pfor trend = 0.002) after adjustment for demographic parameters and risk factors. During a median follow-up of 930 days, 132 deaths (9.95%) were registered. Patients with high levels of Lp(a) (>19.1 mg/dL) had the worst long-term prognosis (Pfor trend < 0.0001). In a subgroup analysis, patients with higher Lp(a) still had the highest all-cause mortality. Additionally, the mRNA expression levels of LPA in patients with STEMI with lower cardiac function were higher than those in other groups (P = 0.003). A higher coronary atherosclerotic burden was correlated with higher LPA expression (P = 0.01).Conclusion: This study provides the first evidence that Lp(a) (at both the protein and mRNA levels) is independently associated with coronary atherosclerotic lesions and prognosis in patients with STEMI treated with PCI.Clinical Trial Registration:http://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900028516.

Background: The presence of no-reflow can increase the risk of major adverse cardiac events and is widely regarded as an important sign of serious prognosis. Previous studies show that laminin receptor (LR) is closely related to the morphology and function of microvessels. However, whether LR is involved in the occurrence and development of no-reflow is still unknown. Methods: In vivo, positron emission tomography (PET) perfusion imaging was performed to detect the effects of intramyocardial gene (LR-AAV and LR-siRNA-AAV) delivery treatment on the degree of no-reflow. In vitro, LC-MS/MS analysis was conducted to identify the LR phosphorylation sites of human cardiac microvascular endothelial cells (HCMECs) treated with oxygen-glucose deprivation (OGD) for 4 h. Western blot analyses were used to evaluate the phosphorylation levels of LR at residues Tyr47 (phospho-Tyr47-LR/pY47-LR) and Thr125 (phospho-Thr125-LR/pT125-LR) and their effects on the phosphorylation of VE-cadherin residue Ser665 (phospho-Ser665-VE-cad). Findings: LR over-expression, LRT125A (phosphonull) and LRY47A (phosphonull) treatments were found to reduce the level of phospho-Ser665-VE-cad, and subsequently maintain adherent junctions and endothelial barrier integrity in hypoxic environments. Mechanistically, TIMAP/PP1c can combine with LR on the cell membrane to form a novel LR-TIMAP/PP1c complex. The level of pY47-LR determined the stability of LR-TIMAP/PP1c complex. The binding of TIMAP/PP1c on LR activated the protein phosphatase activity of PP1c and regulated the level of pT125-LR. Interpretation: This study demonstrates that low level of phospho-LR reduces no-reflow area through stabilizing the LR-TIMAP/PP1c complex and promoting the stability of adherens junctions, and may help identify new therapeutic targets for the treatment of no-reflow.

Background: The phenomenon of no-reflow is defined as the occurrence of areas with very low tissue flow after the target vessel has reopened. Current knowledge suggests that the no-reflow phenomenon is caused by the damage to microvascular integrity established both during ischemia and during reperfusion. D-dimer is the end product of fibrin degradation by plasmin, as plasma concentrations increase in people with persistent or recent thrombosis. Its levels reflect the rate of fibrin turnover and give an indirect estimate of the size of the coagulant mass available for fibrinolysis and the severity of the hypercoagulable condition. Objective: To investigate the Clinical and laboratory predictors of no-reflow on admission after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients. Patients and methods: A prospective single group observational study. A total of 100 patients presented with STEMI and eligible for primary PCI to the cardiology department in Ain Shams University hospital. Results: Coronary angiography showed that (74%) had normal flow while (26%) showed no re-flow. Renal impairment, DM and delayed reperfusion (> 4 hr) were significantly associated with no reflow(P-values = 0.018,0.023,0.005) respectively. ROC curve showed that the best cut off point for D-dimer to predict cases with no reflow was found ≥ 560 with sensitivity of 96.15%, specificity of 79.73% and area under curve (AUC) of 86.5% where as the best cut off point for CRP was > 41 with sensitivity of 76.92%, specificity of 64.86% and area under curve (AUC) of 69.8. Conclusion: Assessment of D-dimer and CRP levels on admission in STEMI patients might independently predicts no-reflow after primary PCI. [ABSTRACT FROM AUTHOR]

Drug-eluting stents have significantly contributed to reducing mortality in patients with ST-segment elevation myocardial infarctions (STEMIs), but slow-flow/no-reflow phenomenon (SFNR) and in-stent restenosis are still clinical problems. In contrast, perfusion balloons (PBs) can compress thrombi and ruptured plaque for long inflation without ischemia and can be used as a delivery device for infusion of nitroprusside to distal risk area during ballooning. We conducted a Reduction of risk bY perfUsion balloon for ST-segment Elevated myocardial Infarction (RYUSEI) study to evaluate whether PBs before stenting are more effective than conventional stenting for STEMIs. We divided consecutive patients with STEMIs who underwent optical coherence tomography (OCT)-guided percutaneous coronary intervention into PB group who were treated with PBs (Ryusei; Kaneka Medix Corporation, Osaka, Japan) before stenting and the conventional percutaneous coronary intervention (CP) group. We compared clinical results including SFNR, OCT findings, and clinical events between the 2 groups. We finally analyzed 34 patients in PB group and 90 in CP group. After propensity score-matching, PB and CP groups consisted of 23 patients, respectively. In the propensity score-matched cohort, SFNR and maximum protrusion area detected by OCT were significantly lower (p = 0.047 and p = 0.019), and thrombolysis in myocardial infarction flow grade 3 was higher (p = 0.022) in the PB group than CP group. Kaplan-Meier analysis revealed a significantly better clinical outcome in PB group than CP group (p = 0.038). In conclusion, the RYUSEI study revealed a pre-stent lesion modification in addition to nitroprusside infusion using PB is useful to achieve better clinical courses in STEMI patients., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Context: The possible pathophysiological mechanisms of no-reflow are ischemic injury, reperfusion injury, endothelial injury, distal thromboembolism, etc., Moreover, no-reflow can also remarkably increase the risks of acute myocardial infarction, heart failure, malignant arrhythmia, pericardial tamponade, and even death. Aims: The aim was to evaluate the efficacy of sodium nitroprusside combined with verapamil in the treatment of no-reflow. Settings and Design: From December 2016 to December 2017, 100 patients with no-reflow during coronary intervention in our hospital were selected and randomly divided into two groups: treatment group (50 cases) treated by sodium nitroprusside combined with verapamil and control group (50 cases) treated with sodium nitroprusside treatment alone. Subjects and Methods: The blood flow grading of the two groups according to a thrombolysis test in myocardial infarction (TIMI) was compared and analyzed, and the incidence of cardiovascular adverse events was compared in the 6-month period following the operation. Statistical Analysis Used: SPSS 17.0 (IBM, America) was employed in all calculations. Quantitative data were expressed as mean ± standard deviation, and intergroup comparison was calculated using a two-tailed t-test. Qualitative data were presented in percentages, and intergroup comparison was performed with Chi-square test.P < 0.05 was considered statistically significant. Results: The patients with TIMI Grade III blood flow in the treatment group were significantly more than those in the control group after medication, and the difference was statistically significant (P < 0.05). In the following 6-month period after the operation, the incidence of cardiovascular adverse events in the treatment group was 6.00% (3/50), which was lower than that in the control group 18.0% (9/50), with statistically significant difference (P < 0.05). Conclusions: Sodium nitroprusside combined with verapamil can significantly improve the no-reflow following coronary interventional therapy and reduce the incidence of adverse cardiovascular events.

Развитие феномена коронарной микрососудистой обструкции (no-reflow) при чрескожных коронарных вмешательствах у пациентов с инфарктом миокарда оказывает существенное негативное влияние на кратко- и долгосрочный прогноз. В основе развития данного состояния лежит крайне неоднородная группа причин, что во многом определяет значительные трудности прогнозирования и лечения. Применение современных лечебных подходов оказывает опосредованное кардиопротективное действие и безусловно снижает риск развития no-reflow. Однако попытки создания препарата или метода, позволившего бы принципиально улучшить прогноз у пациентов с коронарной микрососудистой обструкцией, являются малоэффективными. Цель настоящего обзора — анализ актуальной литературы, посвященной этиологии, патогенезу, диагностике, прогнозированию и лечению феномена коронарной микрососудистой обструкции при выполнении чрескожных коронарных вмешательств у пациентов с инфарктом миокарда. Поиск статей для написания данного обзора осуществлялся с помощью баз данных Medline (PubMed), РИНЦ (eLIBRARY), Embase и Google Scholar. Поступила в редакцию 13 января 2020 г. Принята к печати 11 февраля 2020 г. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов. Финансирование. Исследование не имело спонсорской поддержки.

Weiran Dai, Ziliang Ye, Lang Li, Qiang Su Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China Background: Previous studies have shown that ticagrelor is more effective than clopidogrel in platelet inhibition. However, this conclusion remains controversial. Therefore, we performed this meta-analysis to assess the effect of preoperative loading dose ticagrelor and clopidogrel on no-reflow (NRF) during intervention in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). Materials and methods: Randomized controlled trials and observational studies were reviewed. The retrieval time was limited from inception to October 1, 2017. The retrieved databases included PubMed, Embase, the Cochrane Library, Web of Science, CBM, CNKI, the VIP database, and the Wang Fang database. RevMan 5.3 software was used for data analysis. Results: Fourteen randomized controlled trials and one observational study, including 4,162 patients, were included. In these articles, 1,521 patients were in the ticagrelor group (180 mg) and 2,641 patients were in the clopidogrel group (600 mg). The meta-analysis showed that compared with clopidogrel group, preoperative loading dose ticagrelor: 1) significantly reduced the incidence of NRF during PPCI (95% confidence interval [CI]: 0.15, 0.39, P

Introduction: No-reflow is one of the major complications of primary PCI in patients with acute ST elevation myocardial infarction. This phenomenon is associated with adverse outcomes in these patients. In the current study, we evaluated the effectiveness of CHA2DS2-VASc score in predicting no-reflow phenomenon. CHA2DS2-VASc score is a risk stratification method to estimate the risk of thromboembolism in patients with atrial fibrillation. Methods: In total, 396 patients with ST elevation myocardial infarction who had undergone primary PCI were evaluated in our study. Based on post interventional TIMI flow rate results, the patients were divided into two groups: control group (294 patients) and no-reflow group (102 patients). The CHA2DS2-VASc score was calculated for each participant. Multivariate regression analysis was performed to determine the predictive value of this score. Results: Our findings showed that CHA2DS2-VASc score can predict no-reflow independently (odds ratio: 3.06, 95%, confidence interval: 2.23-4.21, P

Objective: Studies examining the effects of tirofiban combined with other conventional drugs for treating patients with acute coronary syndrome (ACS) are lacking. Thus, in this study, we conducted a meta-analysis investigating both the safety and efficacy of intracoronary (IC) administration of tirofiban treatment alone versus in combination with other conventional treatments for the no-reflow phenomenon (NRP) during percutaneous coronary intervention (PCI) in patients with ACS. Methods: PubMed, Cochrane Library, Embase, Chinese Biomedical (CBM), Google Scholar, and China National Knowledge Infrastructure (CNKI) databases were searched for randomized controlled trials (RCTs) that included data comparing tirofiban treatment alone versus in combination with other conventional therapies. Two independent reviewers evaluated the quality of all data and studies were evaluated according to the Cochrane Collaboration Handbook 5.3. Results: Thirteen RCTs involving 937 patients were included in our analysis. Tirofiban plus conventional drug treatment improved thrombolysis in myocardial infarction (TIMI) grade 3 flow (OR: 0.18; 95% CI: 0.11-0.30; p<0.01), corrected TIMI frame count (CTFC) (WMD: 6.61; 95% CI: 4.69-8.53; p<0.01), and corrected left ventricular ejection fraction (LVEF) (WMD: -3.76; 95% CI: -4.70 to -2.82; p<0.01) and reduced major adverse cardiovascular events (MACE) (OR: 3.9; 95% CI; 2.51-6.07; p<0.01). Tirofiban plus conventional therapy reduced bleeding; however, no statistical significance was observed (OR: 1.24; 95% CI: 0.50-3.12; p=0.64). Conclusion: IC administration of tirofiban combined with conventional drugs is more effective than tirofiban treatment alone for no-reflow (NR) during PCI without increasing bleeding events. This combination is recommended as an optimal strategy for preventing NR. [ABSTRACT FROM AUTHOR]

MicroRNA-208a is a cardiac specific oligo-nucleotide. We aimed at investigating the ability of microRNA-208a to diagnose myocardial infarction and predict the outcome of primary percutaneuos coronary angiography (PCI). Patients (n = 75) presented by chest pain were recruited into two groups. Group 1 (n = 40) had ST elevation myocardial infarction (STEMI) and underwent primary PCI: 21 patients had sufficient reperfusion and 19 had no-reflow. Group 2 (n = 35) had negative cardiac troponins (cTns). Plasma microRNA-208a expression was assessed using quantitative polymerase chain reaction and patients were followed for occurrence of in-hospital major adverse cardiac events (MACE). MicroRNA-208a could diagnose of MI (AUC of 0.926). After primary PCI, it was superior to cTnT in prediction of no-reflow (AUC difference of 0.231, P = 0.0233) and MACE (AUC difference of 0.367, P = 0.0053). Accordingly, circulating levels of miR-208a can be used as a diagnostic marker of MI and a predictor of no-reflow and in-hospital MACE. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the efficacy of intracoronary injection of nicorandil on patients with acute myocardial infarction (AMI) after first percutaneous coronary intervention (PCI) without reflow phenomenon (NR). Methods Computer searched PubMed, Cochrane Library, Wily Online Library, Embase, CNKI, Wanfang Data Knowledge Service Platform, Weipu and other databases, and collected data from the establishment of the database until July 1, 2019 on intracoronary injection of nicorandil. A randomized controlled trial (RCT) study for the treatment of NR after the first PCI in patients with AMI. RevMan5.3 software was used for meta-analysis. Results A total of 7 RCTs were included, involving 739 patients. The results of meta-analysis showed that the incidence of NRP or slow blood flow, corrected TIMI frame number (cTFC), left ventricular ejection fraction (LVEF), and incidence of malignant arrhythmia in the nicorandil group were significantly better than those in the control group, with differences Statistically significant (P <0.05). Conclusion Intracoronary injection of nicorandil before PCI can reduce the incidence of postoperative NRP and cTFC in patients with AMI, increase the level of postoperative LVEF, and reduce the incidence of postoperative malignant arrhythmias. [ABSTRACT FROM AUTHOR]

Background: No-reflow occurs in 3-4% of all percutaneous coronary interventions (PCIs) and has a strong negative impact on clinical outcomes of acute coronary syndrome (ACS). Therefore, the discovery of a biomarker that can early predict the occurrence of no-reflow has great clinical significance. Multiple factors including platelet activation are relevant to no-reflow. Calprotectin is found to be a biomarker of plaque instability and is identified to be a novel diagnostic and prognostic biomarker of cardiovascular diseases. The association of plasma calprotectin with platelet activation and no-reflow phenomenon in ACS is not clear.Methods: In this prospective study performed at Yantai Yuhuangding Hospital from 2017 to 2018, a total of 176 Chinese patients with ACS who had undergone PCIs were recruited consecutively, aged from 30 to 88 years. Angiographic no-reflow was defined as thrombolysis in myocardial infarction grade less than 3. Blood samples were collected immediately at admission for the detection of plasma calprotectin and platelet-monocyte aggregates formation. Statistical analysis was performed for the variable's comparisons between groups and the prediction value of plasma calprotectin for no-reflow.Results: The mean age of the 176 included ACS patients were 64(±11) years and acute ST-segment elevation myocardial infarction (STEMI) was present in 41.5% of patients. Twenty-two patients had no-reflow during the PCI procedures and the prevalence was 12.5%. Patients with higher plasma calprotectin had a higher level of platelet-monocyte aggregates (PMA) and a higher prevalence of no-reflow (p < 0.001). The multivariate regression showed that plasma calprotectin and admission hs-cTnI were independently associated with PMA, while plasma calprotectin and serum LDL-c were independent predictors of no-reflow (p < 0.001 and p = 0.017). AUC of calprotectin for predicting no-reflow were 0.898. The cut-off value of plasma calprotectin for no-reflow was 4748.77 ng/mL with a sensitivity of 0.95 and a specificity of 0.77.Conclusion: Plasma calprotectin was associated with platelet activation and may act as an early predictive biomarker of no-reflow in patients with acute coronary syndrome. [ABSTRACT FROM AUTHOR]

Objective To evaluate the sustained therapy of intragastric administration of Tongxinluo on microvascular endothelial barrier injury swine after the late-stage of acute myocardial infarction (AMI) -reperfusion. Methods: Forty swine were randomly divided into the sham operation group, control group, low-dose (0. l glkg), medium-dose (0. 2 glkg) and high-dose (0. 4 glkg) groups. The AMI and reperfusion model was established by 90 min occlusion of left anterior descending, followed by 120 min reperfusion. No coronary artery was blocked in the sham operation group. Tongxinluo was administrated with double routine dosage before coronary occlusion and with routine dosage from the next day till the seventh day, which was 0. 1, 0. 2, and 0. 4 glkg, respectively. The serum levels of endothelin-1 (ET-1) and von Willebrand Factor (vWF) were detected by ELISA. Patholo护c myocardial tissues were collected seven days after acute ischemia and reperfusion. The mRNA and protein expression levels of endothelial nitric oxide synthase (eNOS) and vascular endo-thelial cadherin ( VE-cadherin) were detected by in situ hybridization ( !SH) and Western blotting. Results: Compared with the sham operation group, the serum ET-1 and vWF increased significantly after coronary occlusion in the control group. On the 7th day of reperfusion, both ET-1 and vWF were restored, but vWF was still significantly higher than that in the sham operation group. Compared with the control group, the serum ET-1 of the high-dose group significantly decreased at 90 min of coronary occlusion, at 120 min, l and 3 days of reperfusion, while v WF decreased at all check points. Compared with the sham operation group, the pos山ve expression of eNOS and VE-cadherin mRNA of infarcted area significantly decreased in the other groups on the 7th day of reperfusion, as well as the eNOS, but VE-cadherin significantly decreased only in the control, low-dose and medium-dose groups. Compared with the control group, Tongxinluo increased both mRNA and protein expression of eNOS and VE-cadherin, which was more significantly effective in the infarcted area than the marginal and normal area with high dosage ( all P < 0. 05) . Conclusion: The intragastric administration of Tongxinluo can alleviate the injury of microvascular endothelial barrier on the 7th day after is chemic reperfusion, with a dose-dependent manner, and be more effective in the infarcted area. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of intracoronary verapamil vs adenosine in restoration of coronary blood flow, post PCI in patients with No-Reflow. Study Design: Double blind (patient/operator blind) randomized control trial. Place and Duration of Study: Cath lab of AFIC & NIHD Rawalpindi, from Feb 2019 to Aug 2019. Methodology: A total of ninety (n=90) patients of either gender between age 25-80 years of age who underwent angioplasty for STEMI/NSTEMI demonstrating No-Reflow (thrombolysis in myocardial infarction 0,1,2) post PCI were enrolled and were randomized into two groups. Group A received verapamil 500 µg in 10 ml heparinized saline, given slowly over 1 minute and group B received adenosine 60 µg in 10 ml of heparinized saline, given quickly. After the administration of both drugs repeat angiogram was carried out and thrombolysis in Myocardial Infarction flow was assessed. Restoration of blood flow was defined as achievement of thrombolysis in myocardial infarction 3 grade. Results: Efficacy (restoration of thrombolysis in Myocardial Infarction grade 3) was better with intracoronary administration of verapamil when compared with intracoronary administration 2 of adenosine (84.4% vs 80%). The difference was, however, not statistically significant (p=0.581). Conclusion: Efficacy (restoration of thrombolysis in myocardial infarction grade 3) was not statistically significant between intracoronary administration of verapamil and adenosine in no-reflow cases after PCI in patients with STEMI/NSTEMI. [ABSTRACT FROM AUTHOR]

Because the phenomenon of no reflow has a poor prognosis in ST-segment elevation myocardial infarction (STEMI) patients and the atherogenic index of plasma (AIP) has been shown to be a strong predictor of coronary heart disease, we aimed to investigate the relationship between AIP and no-reflow in patients with acute STEMI who underwent primary percutaneous coronary intervention (PCI). A total of 763 consecutive STEMI patients (648 men; mean age 58 ± 12 years) who underwent primary PCI were recruited for this study. The patients were classified into a reflow group (n = 537) and a no-reflow group (n = 226) according to the postprocedural angiographic features of thrombolysis in the myocardial infarction flow of the infarct-related artery. The AIP value was significantly higher in the no-reflow group than in the reflow group [0.50 (0.38-0.65) vs. 0.39 (0.25-0.49) p < .001], and AIP was found to be an independent predictor of no-reflow development. The best cut-off value of AIP for predicting no-reflow was 0.54, with sensitivity of 46.02 and specificity of 84,73. In addition, the predictive power of AIP was greater than that of triglycerides and high-density lipoprotein cholesterol based on a receiver operator curve comparison. The AIP was independently associated with no-reflow in patients with STEMI after primary PCI. This might be a superior indicator compared to traditional lipid profiles. [ABSTRACT FROM AUTHOR]

C-reactive protein (CRP) and high-sensitivity CRP (hsCRP), along with a series of hematological indices, platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), platelet distribution width (PDW), and red blood cell distribution width (RDW), are regarded to be related to the incidence of no-reflow or slow flow. Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, Google Scholar, Clinical Trials, and science direct from their inception to August 24, 2019. A total of 21 studies involving 7403 patients were included in the meta-analysis. Pooled analysis results revealed patients with higher hsCRP (odds ratio [OR] = 1.03, 95% confidence interval [CI], 1.01-1.05, P =.006), hsCRP (OR = 1.04, 95% CI: 1.0-1.08, P =.012), NLR (OR = 1.23, 95% CI: 1.11-1.37, P <.0001), PLR (OR = 1.13, 95% CI: 1.07-1.20, P <.0001), and MPV (OR = 2.13, 95% CI: 1.57-2.90, P <.0001) all exhibited significantly higher no-reflow incidence, but there was no significant association between no-reflow risk and RDW or PDW. Patients with higher CRP/hsCRP also performed higher rate of slow flow (OR = 1.06, 95% CI: 1.01-1.11, P =.018). Preangiographic CRP/hsCRP could independently predict no-reflow and slow flow. Moreover, some hematological indices are associated with no-flow. [ABSTRACT FROM AUTHOR]

There is a lack of evidence regarding the association of atrial fibrillation (AF) and no-reflow (NR) phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI). A total of 2452 patients with STEMI who underwent pPCI were retrospectively investigated. After exclusions, 370 (14.6%) patients were in the AF group and 2095 (85.4%) were in the No-AF group. Patients with a thrombolysis in myocardial infarction flow rate <3 were defined as having NR. Patients in the AF group were older and had higher 3-vessel disease rates (24.1% vs 18.9%; P =.021) and lower left ventricular ejection fraction (45.4 [11.7] vs 48.7 [10.5%]; P <.001). No-reflow rates were higher in the AF group than in the No-AF group (29.1% vs 11.8%; P <.001). According to multivariable analysis, AF (odds ratio: 1.81, 95% confidence interval: 1.63-2.04, P <.001), age, Killip class, anterior myocardial infarction, diabetes mellitus, chronic kidney disease, stent length, and smoking were independent predictors of NR following pPCI. Atrial fibrillation is a quite common arrhythmia in patients with STEMI. Atrial fibrillation was found to be an independent predictor of NR in the current study. This effect of AF on coronary flow rate might be considered as an important risk factor in STEMI. [ABSTRACT FROM AUTHOR]

The no-reflow phenomenon increases mortality and morbidity in patients with ST-segment elevation myocardial infarction (STEMI). Inflammation, endothelial dysfunction, and oxidative stress play important role in its pathophysiology. We aim to evaluate the relationship between the no-reflow phenomenon and C-reactive protein (CRP) and uric acid (UA) to albumin ratio (CUAR), which is a new marker indicating all these pathophysiological mechanisms. Study population were divided into two groups as no-reflow and reflow; according to the post-procedural thrombolysis in myocardial infarction flows and myocardial blush grade. A1:4 propensity score matching was performed.CUAR was calculated by using the following formula: log10 (CRP x UA /Albumin). CUAR levels were significantly higher in patients with no-reflow than in those with reflow (P < 0.001). CUAR levels above 1.28 predicted no-reflow with higher sensitivity of 74% and specificity of 71% than all including CRP, UA and albumin (AUC = 0.80 [95%CI: 0.76–0.83], P < 0.001). In multivariate logistic regression analysis, CUAR levels above 1.28 (OR: 4.43 [3.04–6.46], 95% CI; P < 0.001) wereindependently associated with no-reflow phenomenon. Our results showed that CUAR could be a basic and available marker to predict no-reflow in patients with STEMI who underwent primary percutaneous coronary intervention. • The no-reflow phenomenon is still a challenge, which is associated with long-term mortality and morbidity in STEMI patients. • The mechanism of no-reflow includes interactions among inflammation, reactive oxygen damage, and endothelial dysfunction. • CUAR could indicate the composite effect of inflammation, endothelial damage and oxidative stress. • CUAR is independently associated with no-reflow phenomenon in STEMI patients. • It can be used as a simple and available new marker to predict high-risk patients with the no-reflow phenomenon. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease and acute coronary syndrome (ACS) are the major causes of death, worldwide. Risk assessment for patients with ACS is necessary to minimize morbidity and mortality. The global registry of acute coronary events risk score (GRS), the in thrombolysis myocardial infarction (TIMI) risk score (TRS), and the TIMI risk index (TRI) have been used for patients with ACS to evaluate their risk. We showed at our study the value of pre-admission TRI, TRS, and GRS in occurrence prediction of no-reflow (NRF) Phenomenon after primary PCI for ST-elevation myocardial infarction (STEMI) patients; and its impact on the in-hospital outcome for those patients. Patients and Methods: Our study included 319 patients presented with STEMI and managed by primary PCI. For all patients, we recorded a detailed history, clinical examination as well as Killip class, electrocardiogram, and echocardiography. TRI as well, TRS, and GRS were calculated for all patients. We observed all patients during their PCI at the catheterization room to monitor the result of the intervention. NRF was defined as TIMI flow grade less than III or TIMI flow Grade III with myocardial blush grade less than or equal to II. Then, we followed the patients during their hospitalization period to record any associated complications and mortality. Results: We found NRF patients older than reflow patients, thus regarding age. They were more males. Killip Class III-IV was found to be more common in NRF patients. TRI as well, TRS and GRS showed higher values among the NRF patients. As well, in-hospital major adverse cardiac events (MACEs) and mortality were more common in NRF patients. Conclusion: We found that the high TRI values were related to the occurrence of NRF, in hospital MACE, and mortality.

Reopening of the cerebral artery after occlusion often results in “no-reflow” that has been attributed to the death and contraction (rigor mortis) of pericytes. Since this hypothesis still needs to be confirmed, we explored the effects of oxygen glucose deprivation (OGD) on viability and cell death of primary rat pericytes, in the presence or absence of neurovascular unit-derived cytokines. Two morphodynamic parameters, single cell membrane mobility (SCMM) and fractal dimension (Df), were used to analyze the cell contractions and membrane complexity before and after OGD. We found a marginal reduction in cell viability after 2–6 h OGD; 24 h OGD caused a large reduction in viability and a large increase in the number of apoptotic and dead cells. Application of erythropoietin (EPO), or a combination of EPO and endothelial growth factor (VEGFA1−165) during OGD significantly reduced cell viability; application of Angiopoietin 1 (Ang1) during OGD caused a marginal, insignificant increase in cell viability. Simultaneous application of EPO, VEGFA1−165, and Ang1 significantly increased cell viability during 24 h OGD. Twenty minutes and one hour OGD both significantly reduced SCMM compared to pre-OGD values, while no significant difference was seen in SCMM before and after 3 h OGD. There was a significant decrease in membrane complexity (Df) at 20 min during the OGD that disappeared thereafter. In conclusion, OGD transiently affected cell mobility and shape, which was followed by apoptosis in cultured pericytes. Ang1 may have a potentiality for preventing from the OGD-induced apoptosis. Further studies could clarify the relationship between cell contraction and apoptosis during OGD.