Association of the Scottish Inflammatory Prognostic Score With the No-Reflow Phenomenon in Patients With ST-Segment
Fatih Aydın1, Bektas Murat1, Selda Murat2
1Department of Cardiology, Eskisehir City Hospital, Turkey.
Insights
The Scottish Inflammatory Prognostic Score (SIPS) shows a graded association with no-reflow after percutaneous coronary intervention in STEMI patients. However, SIPS was not an independent predictor, unlike diabetes mellitus.
Area of Science:
- Cardiology
- Interventional Cardiology
- Inflammation Research
Background:
- No-reflow is a significant complication of percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI).
- Systemic inflammation is implicated in no-reflow, necessitating simple prognostic tools.
- The Scottish Inflammatory Prognostic Score (SIPS), based on neutrophil count and serum albumin, has potential but requires validation for no-reflow prediction.
Purpose of the Study:
- To evaluate the association between admission Scottish Inflammatory Prognostic Score (SIPS) and the occurrence of angiographic no-reflow in STEMI patients undergoing PPCI.
- To determine if SIPS can serve as a prognostic tool for no-reflow in this patient population.
Main Methods:
- A cohort of 1018 STEMI patients undergoing PPCI between 2020-2025 was analyzed.
- Admission SIPS was calculated, and no-reflow was defined as post-PPCI TIMI flow <3 without mechanical obstruction.
- Statistical analyses included chi-square, ROC analysis, and multivariate logistic regression to assess associations.
Main Results:
- No-reflow occurred in 13.0% of patients, with an increasing incidence across low (10.2%), moderate (15.9%), and high (16.5%) SIPS categories (P=.022).
- SIPS demonstrated modest discriminative ability (AUC=0.563, P=.019), comparable to neutrophil count alone.
- Diabetes mellitus was the only independent predictor of no-reflow (OR 1.30, P=.032), while SIPS categories were not significant after multivariable adjustment.
Conclusions:
- Higher admission SIPS is associated with an increased risk of no-reflow in STEMI patients undergoing PPCI in a graded manner.
- Despite the association, SIPS did not emerge as an independent predictor of no-reflow in this study.
- Diabetes mellitus remains the sole independent predictor identified for no-reflow in this cohort.
Abstract:
No-reflow is a serious complication of PPCI in STEMI. Systemic inflammation plays a role, but simple prognostic tools are needed. The Scottish Inflammatory Prognostic Score (SIPS), combining neutrophil count and serum albumin, shows promise in other areas but hasn't been tested for no-reflow. The present study aimed to investigate the association between admission SIPS and angiographic no-reflow in STEMI patients undergoing PPCI. One thousand eighteen consecutive STEMI patients undergoing PPCI between 2020 and 2025 were analysed. SIPS was calculated on admission. No-reflow was defined as post-procedural thrombolysis in myocardial infarction (TIMI) flow <3 without mechanical obstruction. Associations were assessed using chi-square, receiver operating characteristic (ROC) analysis, and multivariate logistic regression. No-reflow occurred in 132 patients (13.0%), increasing with SIPS: 10.2% (low), 15.9% (moderate), 16.5% (high; P = .022). SIPS had modest discriminative ability (area under Curve [AUC] = 0.563, P = .019), similar to neutrophil count. Diabetes was independently linked to no-reflow (OR 1.30, P = .032); SIPS categories were not. Higher admission SIPS was associated with increased no-reflow risk in a graded pattern but did not emerge as an independent predictor after multivariable adjustment. DM was the sole independent predictor identified.
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