Evaluation of related factors, prediction and treatment drugs of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction after direct PCI

Li,Hui; Fu,Du-Guan; Liu,Fu-Yuan; Zhou,Heng; Li,Xiao-Mei

doi:10.3892/etm.2018.5900

Evaluation of related factors, prediction and treatment drugs of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction after direct PCI

Authors:
- Hui Li
- Du-Guan Fu
- Fu-Yuan Liu
- Heng Zhou
- Xiao-Mei Li
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Affiliations: Department of Cardiovascularology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
Published online on: February 27, 2018 https://doi.org/10.3892/etm.2018.5900
Pages: 3940-3946
Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

This study determined the related factors of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) after direct percutaneous coronary intervention (PCI), and evaluated related factor scores in predicting the occurrence of no-reflow phenomenon and drug treatments. A total of 203 patients with acute STEMI receiving PCI who were admitted to the Department of Cardiovascularology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine (Xiangyang, China) from January 2015 to December 2016 were selected. The clinical and image data were analyzed to determine the related factors of no-reflow phenomenon after operation, and related factor scores were quantified to predict the occurrence of no-reflow phenomenon. Three drugs (diltiazem, nitroglycerin and tirofiban needles) were continuously injected in coronary arteries of patients with no-reflow phenomenon, and the effects of these drugs were analyzed. There were 38 patients (18.7%) with no-reflow phenomenon. The correlation analysis showed that 10 factors were associated with no-reflow phenomenon, in which five factors were identified as risk factors, including IRA open-up time ≥8 h, SBP <100 mmHg, Hs-CRP >18 mg/l, thrombus loads, length of the culprit vessel ≥20 mm. The score analysis of related factors of 38 patients with no-reflow phenomenon was conducted. Three points were set for five risk factors each, and 1 point was set for the other five factors each. It was found that the score was approximately normally distributed. The average was 11.5±1.57 points and the lower limit of 95% confidence interval was >8.93 points. The effective rates of three drugs were different (P<0.05), and the pairwise comparison showed their effective rates were not fully identical (P<0.05). The results showed that: i) Τhere are 10 related factors, including five risk factors; ii) related factors with the score ≥9 points can be used for clinical prediction of STEMI after direct PCI; and iii) it is obviously effective to use diltiazem needle and tirofiban needle to treat no-reflow phenomenon, but this conclusion lacks statistical support.

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1	Duyuler PT, Duyuler S and Demir M: Impact of myocardial blush grade on Tpe interval and Tpe/QT ratio after successful primary percutaneous coronary intervention in patients with ST elevation myocardial infarction. Eur Rev Med Pharmacol Sci. 21:143–149. 2017.PubMed/NCBI
2	Lu Y, Li Y, Yao R, Li Y, Li L, Zhao L and Zhang Y: Clinical effect of ticagrelor administered in acute coronary syndrome patients following percutaneous coronary intervention. Exp Ther Med. 11:2177–2184. 2016. View Article : Google Scholar : PubMed/NCBI
3	Lago IM, Marin-Neto JA, Lima-Filho MDO, Filho AP, Figueiredo GL, Haddad JL, Botelho R, Barbosa R, Gianechini UM and Siqueira BD: Does the inhibition of the final common pathway of platelet aggregation reduce the no-reflow phenomenon during primary percutaneous coronary intervention? Tirofiban no Infarto Agudo do miocárdio e a não Reperfusão (TIARA). Rev Bras Cardiol Invasiva. 22:81–86. 2014.http://www.sciencedirect.com/science/article/pii/S2214123515301836May 7–2016 View Article : Google Scholar
4	Celik T, Balta S, Ozturk C, Kaya MG, Aparci M, Yildirim OA, Demir M, Unlu M, Demirkol S, Kilic S, et al: Predictors of No-Reflow phenomenon in young patients with acute ST-Segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology. 67:683–689. 2016. View Article : Google Scholar : PubMed/NCBI
5	Cetin M, Kiziltunc E, Güven Cetin Z, Kundi H, Gulkan B and Cicekcioglu H: A practical method for No-Reflow treatment. Case Rep Cardiol. 2016:95961232016.PubMed/NCBI
6	Modolo R, Figueiredo VN, Moura FA, Almeida B, Quinaglia e Silva JC, Nadruz W Jr, Lemos PA, Coelho OR, Blaha MJ and Sposito AC; Brasilia Heart Study Group, : Coronary artery calcification score is an independent predictor of the no-reflow phenomenon after reperfusion therapy in acute myocardial infarction. Coron Artery Dis. 26:562–566. 2015. View Article : Google Scholar : PubMed/NCBI
7	Liu N, Hou M, Ren W, Cao J, Wu H and Zhou W: Clinical research of treatment with tirofiban for high-risk non-ST-segment elevation acute coronary syndrome during peri-operative intervention operation period. Cell Biochem Biophys. 71:43–47. 2015. View Article : Google Scholar : PubMed/NCBI
8	Carden DL and Granger DN: Pathophysiology of ischaemia-reperfusion injury. J Pathol. 190:255–266. 2000. View Article : Google Scholar : PubMed/NCBI
9	Jaeschke H: Molecular mechanisms of hepatic ischemia-reperfusion injury and preconditioning. Am J Physiol Gastrointest Liver Physiol. 284:G15–26. 2003. View Article : Google Scholar : PubMed/NCBI
10	Dong M, Mu N, Ren F, Sun X, Li F, Zhang C and Yang J: Prospective study of effects of endogenous estrogens on myocardial no-reflow risk in postmenopausal women with acute myocardial infarction. J Interv Cardiol. 27:437–443. 2014. View Article : Google Scholar : PubMed/NCBI
11	Herring MJ, Dai W, Hale SL and Kloner RA: Rapid induction of hypothermia by the ThermoSuit system profoundly reduces infarct size and anatomic zone of no reflow following ischemia-reperfusion in rabbit and rat hearts. J Cardiovasc Pharmacol Ther. 20:193–202. 2015. View Article : Google Scholar : PubMed/NCBI
12	Kurtul A, Ocek AH, Murat SN, Yarlioglues M, Demircelik MB, Duran M, Ergun G and Cay S: Serum albumin levels on admission are associated with angiographic no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Angiology. 66:278–285. 2015. View Article : Google Scholar : PubMed/NCBI
13	Zhou SS, Tian F, Chen YD, Wang J, Sun ZJ, Guo J and Jin QH: Combination therapy reduces the incidence of no-reflow after primary per-cutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction. J Geriatr Cardiol. 12:135–142. 2015.PubMed/NCBI
14	Dong M, Mu N, Ren F, Li F, Zhang C and Yang J: Matrix metalloproteinase-9 in the culprit coronary artery and myocardial No-Reflow. Am J Med Sci. 350:352–356. 2015. View Article : Google Scholar : PubMed/NCBI
15	Pereira LH, Machado JR, Olegario JG, Rocha LP, Silva MV, Guimaraes CS, Reis MA, Castellano LR, Ramalho FS and Correa RR: Interleukin-6 and C-reactive protein are overexpressed in the liver of perinatal deaths diagnosed with fetal inflammatory response syndrome. Dis Markers 2014. 2527802014.doi: 10.1155/2014/252780.
16	Daidoji H, Takahashi H, Otaki Y, Tamura H, Arimoto T, Shishido T, Miyashita T, Miyamoto T, Watanabe T and Kubota I: A combination of plaque components analyzed by integrated backscatter intravascular ultrasound and serum pregnancy-associated plasma protein a levels predict the no-reflow phenomenon during percutaneous coronary intervention. Catheter Cardiovasc Interv. 85:43–50. 2015. View Article : Google Scholar : PubMed/NCBI
17	Calabro P, Golia E and Yeh ET: CRP and the risk of atherosclerotic events. Semin Immunopathol. 31:79–94. 2009. View Article : Google Scholar : PubMed/NCBI
18	Delewi R, Nijveldt R, Hirsch A, Marcu CB, Robbers L, Hassell ME, de Bruin RH, Vleugels J, van der Laan AM, Bouma BJ, et al: Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging. Eur J Radiol. 81:3900–3904. 2012. View Article : Google Scholar : PubMed/NCBI
19	Wang HJ, Rozanski GJ and Zucker IH: Cardiac sympathetic afferent reflex control of cardiac function in normal and chronic heart failure states. J Physiol. 595:2519–2534. 2017. View Article : Google Scholar : PubMed/NCBI
20	Lindner E and Ruppert D: Effects of calcium antagonists on coronary spasm and pulmonary artery contraction in comparison to their antagonistic action against K-strophanthin in isolated guinea pig atria. Pharmacology. 24:294–302. 1982. View Article : Google Scholar : PubMed/NCBI
21	Shapira OM, Alkon JD, Macron DS, Keaney JF Jr, Vita JA, Aldea GS and Shemin RJ: Nitroglycerin is preferable to diltiazem for prevention of coronary bypass conduit spasm. Ann Thorac Surg. 70:883–889. 2000. View Article : Google Scholar : PubMed/NCBI
22	Birnbaum Y, Atar S, Luo H, Nagai T and Siegel RJ: Ultrasound has synergistic effects in vitro with tirofiban and heparin for thrombus dissolution. Thromb Res. 96:451–458. 1999. View Article : Google Scholar : PubMed/NCBI