Research Of The Platelet-to-lymphocyte Ratio In Predicing No-reflow Phenomenon After Primary Percutaneous Coronary Intervention In Patients With Acute ST-segment Elevation Myocardial Infarction

Background:Early reperfusion in patients with acute ST-segment elevation myocardial infarction(STEMI) is associated with an improved prognosis. Primary percutaneous coronary intervention is the best reperfusion strategy in patients with acute STEMI,and about 95%of occluded coronary vessels can be reopened. But, despite the epicardial coronary vessel has been re-established, the myocardial tissue may fail to restore the best myocardial reperfusion.This reperfusion failure at the microvascular level is a state called no-reflow phenomeuon(NR).Previous studies shown that up to 60% of STEMI patients with coronary vessel reperfusion has been occured no-reflow.NR attenuates the beneficial impact of reperfusion therapy significantly, and leads to the deterioration of the cardiac function and prognosis. The pathophysiology of NR is not fully understood and is very complex, it involves many phenomena. No-reflow relates to worse functional recovery,larger myocardial infarct size, higher incidence of complications, and leads to short- and long-term mortality in acute STEMI. Once no-reflow phenomenon appears, it is hard to reverse.Therefore, it is very important for us to identify high-risk patients rapidly, and is necessary to have a simple and practical predictor of no-reflow phenomenon.It is discovered that two Q waves in ECG?Killip class II?the presence of intracoronary thrombus ? angioplasty as unique reperfusion therapy as predictors of no-reflow phenomenon.The early detection of predictors of no-reflow phenomenon will establish measures aimed to reduce its presentation.Recently, abroad researches discovered that the platelet-to-lymphocyte ratio(PLR) is a new predictor for major adverse cardiovascular events.Objective:By analyzing the predictive effect of platelet-to-lymphocyte ratio(PLR) on admission in domestic patients with ST-segment elevation myocardial infarction(STEMI)on no-reflow phenomeuon after primary coronary intervention(PCI), to provide theoretical basis for finding a simple and practical predictor of no reflow.Method:A total of 190 patients with acute STEMI occurring within 12 hours who underwent primary PCI were enrolled. According to the TIMI flow grade after PCI immediately, all the cases were divided into normal flow group(138 cases) and no-reflow group(52 cases).Basic clinical data?laboratory parameters and the results of PCI were compared between two groups. Logistic regression analysis was used to evaluate predictive value of PLR for no-reflow phenomenon after PCI. The ROC curve was used to demonstrate the optimal cut-off value, sensitivity and specificity of PLR on no-reflow phenomenon.Results:The none-reflow group had significantly higher PLR(P = 0.004), more Q-wave count(P = 0.005)in electrocardiogram and higher trombosis intra-coronary(P = 0.023)compared with the normal-reflow group.A cut-off point of 188 predicted no reflow with a insensitivity of 70 % and specificity of 72 %.Conclusion:PLR,Q-wave count ?2 in Electrocardiogram,trombosis intra-coronary are predictors of no-reflow. A cut-off point of 188 predicted no reflow with a better insensitivity and specificity.