Correlation Between No-reflow And Thrombomodulin In Reperfused Pateints With Acute Myocardial Infarction

Objective Coronary reperfusion therapy is widely performed to restore blood flow to the ischemic myocardium in the patents with acute myocardial infarction (AMI). However, patency of the infarct-related artery does not always guarantee adequate myocardial salvage in patients. The no reflow phenomenon is as an uncommon and critical occurrence, if not reversed, it causes advanced myocardial damage and poor clinical outcomes. An ideal reperfusion should be effective microvascular reperfusion in ischemic myocardium. The aim of this study was to analyse the causes of no reflow phenomenon and explore the relative factors for angiographic no reflow phenomenon after reperfusion therapy;to analyse the relation between coronary microembolization and no reflow;to investigate the correlation between no reflow and the change of thrombomodulin (TM).Methods This study compromised 60 consecutive patients with AMI who underwent reperfusion treatments in ED of PLA General hospital. Multiple Logistic regression analysis was used to identify independent relative factors of the no-reflow phenomenon. The changes of thrombomodulin in the patients with AMI and the normal group were measured by enzyme linked immunosorbnent assay (ELISA).Results (1) The average age of no-reflow group was older than good reflow group (65.81±10.47 vs 58.02±12.66). (2) It was a longer time of door-to-needle for no-reflow group compared with good reflow group ( 34.43±54.52 vs 27.82±40.56). (3) There was 35% no-reflow phenomenon in the total AMI group. The factors of the no-reflow phenonmenon related with age, hyperlipemia, diabetes mellitus (DM), multivessel lesion by univariate analysis. (4) There wassignificant difference in the level of TM between AMI group and the contrast group (P<0.05) on the 3rd day after reperfusion. It was also significant between no-reflow group and good reflow group (P<0.05).Conclusions (1) The increased risk of no-reflow and complications of AMI correlated with the time delay of reperfusion, age, DM, hyperlipemia, multiple cononary vessel lesion. (2) The change of TM was significant in patients with no-reflow after reperfusion which could reflect the degree of endothelial reperfusion injury. (3) The change of TM might be an indicator of no-reflow phenomenon caused by microembolization after reperfusion therapy.