Serum Levels Of Von Willebrand Factor, Soluble CD40 Ligand And Angiographic No-reflow After Successful PPCI In Patients With STEMI

Objective Primary percutaneous coronary intervention (PPCI) is an important therapy for patients with acute ST-segment elevation myocardial infarction (STEMI), while the no-reflow phenomenon may inhibit the expected benefit from PPCI. The aim of this study was to investigate whether serum levels of von willebrand factor (vWF) and soluble CD40 ligand (sCD40L) are associated with no-reflow and could predict no-reflow after PPCI in patient with STEMI.Methods 57 consecutive STEMI patients undergoing successful PPCI were studied. On the basis of post-stent TIMI flow and corrected TIMI frame count (CTFC) of target vessels, the patients were divided into two groups, namely no-reflow group (n= 23) and reflow group (n= 44). Their serum level of vWF and sCD40L before and after PCI (within 24 hours) were measured by enzyme linked immunosorbent assay (ELISA), and the difference between two groups was compared, and their association with CTFC of target artery was analyzed. Multivariable logistic regression analysis was applied to identify independent clinical predictors for no-reflow among the variables showing a significant association with no-reflow at univariate analysis.Results There was no significant difference between two groups in serum vWF level before PCI. After PCI, serum vWF level elevated significantly in comparison with that before PCI in both groups, while serum vWF level in no-reflow group was higher than that in reflow group significantly. The average CTFC of post-stent in target artery was positively correlated with serum vWF level after PCI, but not associated with serum vWF level before PCI significantly. The multivariate logistic regression analysis revealed that serum levels of CK-MB before PCI, serum levels of vWF and CK-MB after PCI, statins usage, LVEF on admission, Length of lesion were independent risk or relative factors for no-reflow for STEMI.Conclusion The higher serum levels of vWF and sCD40L either before PPCI or after PPCI are significantly associated with no-reflow, which means they may play key roles in the pathogenesis of no-reflow after PPCI. The serum level of vWF on admission is an independent risk factors for coronary no-reflow in patients with STEMI.