Association and Prognostic Implications of "No-Reflow Phenomenon" and Hypercoagulability in Patients With ST-Segment
Mohamed Omar1, Min Gyu Kang2, Moon Ki Jung3
1Heart and Brain Hospital, Chung-Ang University Gwangmyeong Center, Gwangmyeong, South Korea; Cardiology Department, National Heart Institute of Egypt, Giza, Egypt.
Insights
High clot strength, measured by thromboelastography, increases the risk of the no-reflow phenomenon after percutaneous coronary intervention in STEMI patients. This finding suggests controlling clot strength may improve outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hemostasis and Thrombosis
Background:
- The no-reflow phenomenon post-percutaneous coronary intervention (PCI) is linked to poorer patient outcomes.
- Preventing and treating no-reflow during PCI remains a clinical challenge.
Purpose of the Study:
- To investigate the association between thrombogenicity profiles and the no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI.
- To assess the prognostic implications of heightened thrombogenicity and no-reflow.
Main Methods:
- Prospective enrollment of 334 STEMI patients undergoing primary PCI from a real-world registry.
- Assessment of Thrombolysis In Myocardial Infarction (TIMI) flow grade post-PCI; no-reflow defined as TIMI 0-2.
- Evaluation of thrombogenicity using thromboelastography (TEG) for platelet-fibrin clot strength (P-FCS) and conventional hemostatic assays.
Main Results:
- The no-reflow phenomenon occurred in 11.1% of patients.
- High P-FCS (≥ 68 mm) measured by TEG was significantly associated with an increased risk of no-reflow (OR: 2.611; P=0.010).
- Combined presence of no-reflow and high P-FCS significantly increased the risk of 3-year adverse clinical events (aHR: 6.654; P<0.001).
Conclusions:
- Heightened thrombogenicity, specifically high P-FCS, is closely related to the no-reflow phenomenon after primary PCI in STEMI.
- The combination of no-reflow and high P-FCS has additive prognostic value for adverse clinical events.
- Targeting clot strength may be a strategy to reduce no-reflow and improve clinical outcomes in STEMI patients.
Background:
Following percutaneous coronary intervention (PCI), the "no-reflow phenomenon" is associated with a worse outcome. However, it remains unclear how to prevent and treat this phenomenon during PCI.
Objectives:
This study aimed to evaluate the association between thrombogenicity profiles and "no-reflow phenomenon" during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI).
Methods:
From a real-world registry, we prospectively enrolled patients with STEMI who underwent primary PCI (n = 334). TIMI flow grade was assessed at final angiography, and the "no-reflow phenomenon" was defined as TIMI flow grade between 0 and 2. Thrombogenicity profiles were assessed with thromboelastography (TEG) and conventional hemostatic measurements.
Results:
Thirty-seven patients (11.1%) showed no-reflow after primary PCI. High platelet-fibrin clot strength (P-FCS: ≥ 68 mm) measured by TEG was significantly associated with an increased risk of post-PCI "no-reflow phenomenon" (OR: 2.611; 95% CI: 1.220-5.584; P = 0.010). The risk stratification with "no-reflow phenomenon" and "high P-FCS phenotype" appeared to be additive to predict the risk of 3-year clinical event (log-rank P < 0.001 across the groups). Patients with both "no-reflow phenomenon" and high P-FCS had a higher risk of adverse clinical events compared with normal-reflow subjects with low P-FCS (adjusted HR: 6.654; 95% CI: 2.678-16.530; P < 0.001).
Conclusions:
This study demonstrated a close relationship between heightened thrombogenicity (assessed by TEG P-FCS) with "no-reflow phenomenon," and their additive prognostic implications after primary PCI in STEMI patients. Effective control of clot strength may reduce the risk of "no-reflow phenomenon" and improve clinical outcomes in these patients. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529).
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