Association Between Atherogenic Index of Plasma and No-Reflow After Primary PCI in STEMI

The no-reflow phenomenon is a serious complication following primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). It is associated with poor myocardial perfusion, increased infarct size, and worse clinical outcomes. Recently, the atherogenic index of plasma (AIP) - calculated from triglyceride and HDL-cholesterol levels - has emerged as a potential marker of atherogenic dyslipidemia and cardiovascular risk. However, the relationship between AIP and the occurrence of no-reflow after PCI remains insufficiently explored. Consequently, this study was conducted to investigate the impact of the atherogenic index of plasma (AIP) on the occurrence of the no-reflow phenomenon in patients presenting with STEMI who underwent primary PCI.

A prospective cohort study was conducted including 300 patients with STEMI admitted within 24 hours of symptom onset and treated with primary PCI. Patients managed conservatively or with thrombolytic therapy were excluded. Clinical characteristics, laboratory parameters, angiographic findings, and echocardiographic data were collected and analyzed. Patients were divided into two groups according to the occurrence of the no-reflow phenomenon. Logistic regression analysis was performed to identify independent predictors of no-reflow, and receiver operating characteristic (ROC) curve analysis was used to assess the predictive value of AIP and other biomarkers.

Patients with no-reflow had significantly higher levels of triglycerides, LDL cholesterol, inflammatory markers, and AIP, along with lower HDL levels. Multivariate logistic regression identified AIP as an independent predictor of no-reflow (OR≈1.44, p<0.001). ROC curve analysis showed that AIP demonstrated the highest predictive value among lipid parameters, with an AUC of 0.721 and an optimal cutoff value of ≥0.55, yielding high sensitivity (87.1%) for predicting no-reflow. Other independent predictors included hypertension, family history of coronary artery disease, baseline TIMI flow <3, higher CK-MB levels, triglycerides, LDL cholesterol, reduced eGFR, and longer stent length.

The atherogenic index of plasma is a significant and independent predictor of the no-reflow phenomenon in STEMI patients undergoing primary PCI. AIP may serve as a simple and accessible biomarker for early risk stratification and may help guide preventive strategies to improve clinical outcomes.