title: The association of serum procalcitonin level with the no-reflow phenomenon after a primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction.
abstract: OBJECTIVE
  The no-reflow phenomenon is associated with adverse outcomes in patients with acute ST-elevation myocardial infarction (STEMI) treated by a primary percutaneous coronary intervention (PPCI). Procalcitonin (PCT) is a marker of systemic inflammatory states and an elevated serum PCT concentration is related to an increased risk of cardiovascular events. We aimed to assess whether serum PCT level at admission is an independent predictor of no-reflow in patients with STEMI treated with PPCI.
  
  
  METHODS
  Between November 2012 and December 2014, 501 consecutive patients with STEMI who underwent PPCI within the first 12 h following the onset of symptoms were enrolled. Serum PCT levels were measured on admission. Patients (age: 59±13 years, 73.5% men) were divided into the two groups: no-reflow and reflow. The no-reflow phenomenon was defined as final Thrombolysis In Myocardial Infarction flow grade less than 3 after PPCI.
  
  
  RESULTS
  No-reflow was diagnosed in 91 (18.2%) patients. PCT levels were significantly higher in patients who developed no-reflow than in those who did not [0.102 (0.063-0.247) vs. 0.042 (0.020-0.076) μg/l, P<0.001]. In receiver operating characteristics curve analysis, the cut-off value of PCT was 0.066 μg/l for the prediction of no-reflow (area under the curve: 0.776, 95% confidence interval: 0.720-0.831, P<0.001, sensitivity: 73%, specificity: 70%). On multivariate analysis, serum PCT (>0.066 μg/l) value was an independent predictor of no-reflow (odds ratio: 3.377, 95% confidence interval: 1.572-7.255, P=0.002), together with early patency of culprit artery (P=0.046), Killip class more than or equal to 2 at presentation (P=0.028), and total stent length (P=0.004).
  
  
  CONCLUSIONS
  Increased admission PCT level is associated independently with no-reflow after PPCI in STEMI patients.
authors.affiliation: Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.
authors.forename: Sani N
authors.initials: SN
authors.lastname: Murat
authors.forename: Alparslan
authors.initials: A
authors.lastname: Kurtul
authors.forename: Ibrahim E
authors.initials: IE
authors.lastname: Celik
authors.forename: Mustafa
authors.initials: M
authors.lastname: Duran
authors.forename: Mikail
authors.initials: M
authors.lastname: Yarlioglues
authors.forename: Alparslan
authors.initials: A
authors.lastname: Kilic
authors.forename: Deniz
authors.initials: D
authors.lastname: Elcik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000601:surgery*; D054318:No-Reflow Phenomenon / Q000097:blood* / Q000453:epidemiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D015607:Stents
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide