Genetic Scale for Predicting the No-Reflow Phenomenon in Myocardial Infarction

The aim of the study is to investigate the association of the selected single nucleotide polymorphisms (SNPs) with the development of the no-reflow phenomenon during percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and to create a genetic scale for predicting this complication.

A single-center matched case-control study was conducted. The study included 80 STEMI patients: 40 (50%) with no-reflow and 40 (50%) without no-reflow (1:1 matching by sex and age). No-reflow was defined as TIMI flow grade <3 or Myocardial blush grade <2 after PCI. The following SNPs were assessed: rs4961 (ADD1), rs699 and rs4762 (AGT), rs5186 (AGTR1), rs1403543 (AGTR2), rs1799998 (CYP11B2), rs5443 (GNB3), rs2070744 and rs1799983 (eNOS), rs5370 (EDN1), rs1799963 (F2), rs6025 (F5), rs6046 (F7), rs5985 (F13), rs1800790 (FGB), rs1126643 (ITGA2), rs5918 (ITGB3), rs1799762 (PAI-1), rs1801133 and rs1801131 (MTHFR), rs1805087 (MTR), and rs1801394 (MTRR).

The following SNPs were associated with the development of the no-reflow phenomenon: rs4961 (genotype GT or TT) in the ADD1 gene, rs1799998 (CC) in the CYP11B2 gene, and rs1801133 (CC) in the MTHFR gene (p<0.05, McNemar's test). These SNPs were combined into a genetic prognostic scale, where 1 point was assigned for each genotype associated with no-reflow. The positive predictive value for the maximum score (3 points) was 0.91. The area under the ROC curve was 0.724 (0.611-0.838). The odds ratio for no-reflow development was 5.39 (1.09-26.66) per point (p=0.04; multivariate analysis using conditional logistic regression).