Serum B-type natriuretic peptide on admission can predict the 'no-reflow' phenomenon after primary drug-eluting stent implantation for ST-segment elevation myocardial infarction.
BACKGROUND
The angiographic 'no-reflow' phenomenon after primary percutaneous coronary intervention (PPCI) is associated with a poor short-term and long-term clinical prognosis of ST-elevation myocardial infarction (STEMI). Although the increasing use of primary drug-eluting stent (DES) deployment for STEMI resulted in reduced adverse clinical outcomes, the prevalence of no-reflow has been unchanged. The purpose of our study was to evaluate the predictors for no-reflow for STEMI and identify such high-risk patients in the DES era.


METHODS
The study prospectively enrolled 300 consecutive STEMI patients (80% men; 57+/-11 years) who underwent PPCI within 12 h of symptom onset. The no-reflow phenomenon was defined as an angiographic outcome of Thrombolysis In Myocardial Infarction (TIMI) grade <3 without accompanying mechanical factors.


RESULTS
Compared to normal reflow patients, no-reflow patients (n=15, 5% of the total study population) were older (64+/-13 vs. 57+/-11 years; P=0.019), transferred to hospital later (7.1+/-3.2 vs. 4.5+/-3.8 h; P=0.011), and had a higher TIMI risk score (5.5+/-2.0 vs. 3.8+/-2.2; P=0.004). B-type natriuretic peptide (BNP), high sensitivity C-reactive protein, and serum creatinine levels were higher in the no-reflow than the normal reflow group. Multivariate analysis (including clinical, angiographic and procedural variables with a P<0.2 in univariate analysis) showed that high BNP level on admission was the only independent predictor of no-reflow. The area under the receiver-operating characteristics curve analysis value for BNP was 0.786. BNP > or =90 pg/ml showed a sensitivity of 80% and a specificity of 70% for predicting no-reflow after primary DES implantation (OR 14.953, 95% CI 3.131-71.419, P=0.001).


CONCLUSIONS
Angiographic 'no-reflow' phenomenon after primary DES implantation for STEMI can be predicted by BNP levels on admission. BNP-guided approach may be useful in identifying patients at high risk of the no-reflow phenomenon after primary stenting.
Jeong
Young-Hoon
YH
Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.
Kim
Won-Jang
WJ
Park
Duk-Woo
DW
Choi
Bong-Ryong
BR
Lee
Seung-Whan
SW
Kim
Young-Hak
YH
Lee
Cheol Whan
CW
Hong
Myeong-Ki
MK
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
D000367:Age Factors; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D054318:No-Reflow Phenomenon / Q000097:blood*; D010343:Patient Admission; D010360:Patient Transfer; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D003404:Creatinine