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The predictive value of laboratory parameters for no-reflow phenomenon in patients with ST-elevation myocardial
LinLi Wang1, ShuWei Huang2, Qiujun Zhou3
1Department of Preventive Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Insights
This meta-analysis reveals key laboratory indicators that predict no-reflow risk in ST-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). Elevated white blood cell count, neutrophils, platelets, glucose, creatinine, cholesterol, d-dimer, and fibrinogen increase risk, while hemoglobin decreases it.
Area of Science:
- Cardiology
- Clinical Biochemistry
- Interventional Cardiology
Background:
- The predictive role of laboratory indicators for the no-reflow phenomenon in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains unclear.
- Early identification of patients at high risk for no-reflow is crucial for implementing timely preventive strategies.
Approach:
- A comprehensive meta-analysis was conducted by searching major databases (PubMed, Embase, Cochrane Library) up to October 2023.
- Included were case-control and cohort studies focusing on STEMI patients undergoing primary PCI.
- Data were analyzed using STATA 15.1 to pool results and assess associations between laboratory parameters and no-reflow risk.
Key Points:
- Elevated white blood cell (WBC) count, neutrophil count, platelet (PLT) count, blood glucose, creatinine, total cholesterol (TC), d-dimer, and fibrinogen were significantly associated with an increased risk of no-reflow.
- Conversely, elevated hemoglobin levels were associated with a decreased risk of no-reflow.
- These laboratory parameters demonstrate significant predictive potential for no-reflow in STEMI patients post-PCI.
Conclusions:
- This meta-analysis identifies several laboratory parameters as significant predictors of no-reflow risk in STEMI patients undergoing primary PCI.
- Parameters such as WBC count, neutrophil count, PLT, blood glucose, hemoglobin, creatinine, TC, d-dimer, and fibrinogen can aid in early clinical risk assessment.
- Refined risk prediction using these indicators can guide clinical decision-making for targeted preventive measures to mitigate no-reflow events.
Abstract:
To date, the predictive role of laboratory indicators for the phenomenon of no flow is unclear. Hence, our objective was to conduct a meta-analysis to investigate the association between laboratory parameters and the risk of the no-reflow phenomenon in patients with ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI). This, in turn, aims to offer valuable insights for early clinical prediction of no-reflow. We searched Pubmed, Embase, and Cochrane Library from the establishment of the database to October 2023. We included case-control or cohort study that patients with STEMI following primary PCI. We excluded repeated publication, research without full text, incomplete information or inability to conduct data extraction and animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data. The pooled results indicated that elevated white blood cell (WBC) count (odds ratio [OR] = 1.061, 95% confidence interval [CI]: 1.013-1.112), neutrophil count (OR = 1.324, 95% CI: 1.128-1.553), platelet (PLT) (OR = 1.002, 95% CI: 1.000-1.005), blood glucose (OR = 1.005, 95% CI: 1.002-1.009), creatinine (OR = 1.290, 95% CI: 1.070-1.555), total cholesterol (TC) (OR = 1.022, 95% CI: 1.012-1.032), d-dimer (OR = 1.002, 95% CI: 1.001-1.004), and fibrinogen (OR = 1.010, 95% CI: 1.005-1.015) were significantly associated with increased risk of no-reflow. However, elevated hemoglobin was significantly associated with decreased risk of no-reflow. In conclusion, our comprehensive analysis highlights the predictive potential of various parameters in assessing the risk of no-reflow among STEMI patients undergoing PCI. Specifically, WBC count, neutrophil count, PLT, blood glucose, hemoglobin, creatinine, TC, d-dimer, and fibrinogen emerged as significant predictors. This refined risk prediction may guide clinical decision-making, allowing for more targeted and effective preventive measures to mitigate the occurrence of no-reflow in this patient population.
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