title: Impact of clopidogrel resistance on ST-segment resolution and no-reflow in acute myocardial infarction with ST-elevation patients treated with a primary percutaneous coronary intervention.
abstract: BACKGROUND
  A rapid restoration of epicardial coronary flow in acute myocardial infarction is crucial for saving jeopardized myocardium. The no-reflow phenomenon is one of the major problems in a primary percutaneous coronary intervention (PCI) and may be defined as an outcome of different pathological pathways. Our aim was to evaluate clopidogrel resistance in patients who underwent primary PCI and the relationship with the no-reflow phenomenon.
  
  
  METHODS
  A total of 127 patients (mean age 54.0 ± 11.4 years, 83.7% men) were assessed for this purpose. No-reflow was defined as less than 50% ST-segment resolution on ECG.
  
  
  RESULTS
  No-reflow was significantly frequent in patients with clopidogrel resistance (25.3 vs. 57.1%, P=0.006). Univariate analysis and multivariate analysis showed that clopidogrel resistance and anterior myocardial infarction were only independent predictors of no-reflow phenomenon in patients treated with a primary PCI during acute myocardial infarction.
  
  
  CONCLUSIONS
  Our study showed that clopidogrel resistance may be one of the responsible mechanisms for the no-reflow phenomenon. Assessment of simple ECG after a primary PCI may help clinicians to determine patients with a poor prognosis.
authors.affiliation: Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. emrahbozbeyoglu@hotmail.com
authors.forename: Emrah
authors.initials: E
authors.lastname: Bozbeyoglu
authors.forename: Seckin
authors.initials: S
authors.lastname: Satilmis
authors.forename: Huseyin
authors.initials: H
authors.lastname: Aksu
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yildirimturk
authors.forename: Zekeriya
authors.initials: Z
authors.lastname: Nurkalem
mesh_terms: D000077144:Clopidogrel; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D004351:Drug Resistance; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020127:Recovery of Function / Q000187:drug effects; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine