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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Relation of hemoglobin level to no-reflow in patients with ST-segment elevation myocardial infarction undergoing
Barış Yaylak1, Bernas Altıntaş2, Kazım Serhan Özcan1
1Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Insights
Low hemoglobin levels predict no-reflow in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). Hemoglobin below 11.5 g/dl indicates a higher risk of this complication.
Area of Science:
- Cardiology
- Hematology
Background:
- Acute ST-segment elevation myocardial infarction (STEMI) management aims for early artery reperfusion.
- No-reflow development is multifactorial and not fully understood.
- Anemia is linked to severe cardiovascular disease complications.
Purpose of the Study:
- Investigate the association between hemoglobin levels and no-reflow in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).
Main Methods:
- 3804 STEMI patients undergoing PPCI were analyzed.
- Patients were grouped by Thrombolysis in Myocardial Infarction (TIMI) flow grades post-PPCI.
- Logistic regression assessed the link between hemoglobin and no-reflow.
Main Results:
- 12.4% of patients experienced no-reflow post-PPCI.
- No-reflow patients had significantly lower hemoglobin levels (12.1 g/dl vs. 13.8 g/dl).
- Hemoglobin level was an independent predictor of no-reflow (OR=0.564, p<0.001), with a cutoff of 11.5 g/dl (AUC=0.844).
Conclusions:
- Hemoglobin level demonstrates moderate diagnostic performance for predicting no-reflow in STEMI patients undergoing PPCI.
- Lower hemoglobin levels are associated with an increased risk of no-reflow after PPCI.
Introduction:
The primary goal in the management of acute ST segment elevation myocardial infarction (STEMI) is to open the occluded artery at an early stage. The development of no-reflow is multifactorial, and the etiology is not fully understood. There is accumulating evidence that anemia is related to a series of severe complications in cardiovascular disease (CVD) such as thromboembolic events, bleeding complications, uncontrolled hypertension, and inflammation characterized by elevated levels of inflammatory cytokines.
Aim:
We investigated the relationship between hemoglobin level and the no-reflow of infarct-related artery (IRA) in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI).
Material And Methods:
A total of 3804 patients with acute STEMI who underwent PPCI were enrolled. The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI) flow grades after PPCI. Hematological parameters were measured on admission. Univariate and multivariate logistic regression analyses were conducted to assess the association between hemoglobin level and no-reflow.
Results:
In the current study, 471 (12.4%) patients presented with no-reflow after PPCI. The patients in the no-reflow group had a significantly lower hemoglobin level (12.1 ±1.9 g/dl vs. 13.8 ±1.8 g/dl, p < 0.001). The multivariate logistic regression models revealed that hemoglobin level (OR = 0.564, 95% CI: 0.526-0.605; p < 0.001) was an independent predictor of development of no-reflow. The cutoff value for hemoglobin level was 11.5 g/dl with sensitivity of 83.0% and specificity of 80.0% (AUC = 0.844, 95% CI: 0.821-0.867; p < 0.001).
Conclusions:
Our results suggest that hemoglobin level showed a moderate diagnostic performance regarding the prediction of no-reflow in patients with STEMI undergoing PPCI.
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