Investigation of the relationship between modified Glasgow prognostic score and no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Yıl 2023, Cilt: 9 Sayı: 5 - September 2023, 894 - 902, 04.09.2023

Mustafa Kaplangoray , Kenan Toprak , Cihan Aydın , Ramazan Aslan

https://doi.org/10.18621/eurj.1284893

Cited By: 2

Öz

Objectives: No-reflow phenomenon (NRP) is a complication associated with poor clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The modified Glasgow prognostic score (mGPS) is a novel immune-inflammatory index, derived from C-reactive protein (CRP) and serum albumin levels and has been shown to be associated with prognosis in heart disease. In this study we aimed to investigated the relationship between mGPS and NRP in patients undergoing pPCI for STEMI.

Methods: A total of 379 patients (aged 59 ± 9.9 years; 54.9% male) were enrollled. The patients were divided into 2 groups:no-reflow (n = 72) and reflow (n = 307). No-reflow was defined as thrombolysis in myocardial infarction (TIMI) ≤ 2 flow. The mGPS of all patients was calculated from blood samples at admission. Logistic regression analysis was performed to determine the independent predictive factors for NRP.

Results: Mean age, pain to balloon duration, troponin T, white blood cell (WBC), Syntax score, neutrophil to lymphocyte ratio (NLR), glucose level, C-reactive protein level (CRP), diabetic and female patient ratio were higher, while left ventricular ejection fraction, ST segment resolution ratio at 60 min, and serum albumin level were lower in the NRP group.Logistic regression analysis showed that WBC count [Hazard ratio (HR): 0.816, 95% confidence interval (CI): 0.728-0.914, p < 0.001], NLR (HR: 0.482, CI: 0.355-0.654, p < 0.001), pain-to-balloon time (HR: 0.976, CI:0.960-0.991, p = 0.002) and mGPS (HR: 3.213, CI: 1.643- 6.283, p = 0.001) were independent predictive factors for NRP.

Conclusions: Modified GPS is an independent predictive factor for NRP in patients undergoing pPCI for STEMI.

Anahtar Kelimeler

ST-segment elevation myocardial infarction, modified Glasgow prognostic score, no-reflow phenomenon, primary percutaneous coronary intervention

Kaynakça

• 1. Esenboğa K, Kurtul A, Yamantürk YY, Tan TS, Tutar DE. Systemic immune-inflammation index predicts no-reflow phenomenon after primary percutaneous coronary intervention. Acta Cardiologica 2022;77:59-65.
• 2. Harrison RW, Aggarwal A, Ou FS, Klein LW, Rumsfeld JS, Roe MT. American College of Cardiology National Cardiovascular Data Registry. Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction. Am J Cardiol 2013;111:178-84.
• 3. Caiazzo G, Musci RL, Frediani L, Umińska J, Wanha W, Filipiak KJ, et al. State of the art: no-reflow phenomenon. Cardiol Clin 2020;38:563-73.
• 4. Zehir R, Yılmaz AS, Çırakoğlu ÖF, Kahraman F, Duman H. Modified Glasgow prognostic score predicted high-grade intracoronary thrombus in acute anterior myocardial infarction. Angiology 2023 Feb 17;33197231157929. doi: 10.1177/00033197231157929.
• 5. Cho A, Arfsten H, Goliasch G, BartkoPE, Wurm R, Strunk G, et al. The inflammation based modified Glasgow prognostic score is associated with survival in stable heart failure patients. ESC Heart Failure 2020;7:654-62.
• 6. Zhu H, Li Z, Xu X, Fang X, Chen T, Huang J. Predictive value of three inflammation-based Glasgow prognostic scores for major cardiovascular adverse events in patients with acute myocardial infarction during hospitalization: a retrospective study. Peer J 2020;8;e9068.
• 7. Kurtul A, Ocek AH, Murat SN, Yarlioglues M, Demircelik MB, Duran M, et al. Serum albumin levels on admission are associated with angiographic no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Angiology 2015;66:278-85.
• 8. Celik T, Iyisoy A, Yuksel UC, Jata B, Ozkan M. The impact of admission C-reactive protein levels on the development of no-reflow phenomenon after primary PCI in patients with acute myocardial infarction: the role of inflammation. International J Cardiol 2009;136:86-8.
• 9. Lee CH, Tai BC, Lau C, Chen Z, Low AF, Teo SG, et al. Relation between door to balloon time and microvascular perfusion as evaluated by myocardial blush grade, Ccrrected TIMI frame count, and ST segment resolution in treatment of acute myocardial infarction. J Interv Cardiol 2009;22:437-43.
• 10. Geng N, Ren L, Xu L, Zou D, Pang W. Clinical outcomes of nicorandil administration in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2021;21:488.
• 11. Ozturk E, Esenboga K, Kurtul A, Kilickap M, Karaagaoglu E, Karakaya J. Measurement of uncertainty in prediction of no-reflow phenomenon after primary percutaneous coronary intervention using systemic immune inflammation index: the gray zone approach. Diagnostics (Basel) 2023;13:709.
• 12. Rezkalla SH, Rachel VS, Jennifer H, Kloner RA. No-reflow phenomenon. Circulation 2002;105:656-62.
• 13. Bisoendial RJ, Boekholdt SM, Vergeer M, Stroes ES, Kastelein JJ. C-reactive protein is a mediator of cardiovascular disease. Eur Heart J 2010;31:2087-91.
• 14. Kaul S. The “no reflow” phenomenon following acute myocardial infarction: mechanisms and treatment options. J Cardiol 2014;64:77-85.
• 15. Ito BR, Schmid-Schönbein G, Engler RL. Effects of leukocyte activation on myocardial vascular resistance. Blood Cells 1990;16:145-63.
• 16. Gresele P, Deckmyn H, Huybrechts E, Vermylen J. Serum albumin enhances the impairment of platelet aggregation with thromboxane synthase inhibition by increasing the formation of prostaglandin D2. Biochem Pharmacol 1984;33:2083-8.
• 17. Maalej N, Albrecht R, Loscalzo J, Folts JD. The potent platelet inhibitory effects of S-nitrosated albumin coating of artificial surfaces. J Am Coll Cardiol 1999;33:1408-14.
• 18. Joles JA, Willekes-Koolschijn N, Koomans HA. Hypoalbuminemia causes high blood viscosity by increasing red cell lysophosphatidylcholine. Kidney Int 1997;52:761-70.
• 19. Yip HK, Chen MC, Chang HW, Hang CL, Hsieh YK, Fang CY, et al. Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon. Chest 2002;122:1322-32.
• 20. Kaul S, Methner C, Cao Z, Mishra A. Mechanisms of the “no-reflow” phenomenon after acute myocardial infarction: potential role of pericytes. JACC Basic Transl Sci 2023;8:204-20.
• 21. Yu Y, Wu Y, Wu X, Wang J, Wang C. Risk factors for no-reflow in patients with ST-elevation myocardial infarction who underwent percutaneous coronary intervention: a case-control study. Cardiol Res Pract 2022;2022:3482518.
• 22. Kojima S, Sakamoto T, Ishihara M, Kimura K, Miyazaki S, Tei C, et al. Japanese Acute Coronary Syndrome Study investigators. The white blood cell count is an independent predictor of no-reflow and mortality following acute myocardial infarction in the coronary interventional era. Ann Med 2004;36:153-60.
• 23. Prasad A, Stone GW, Stuckey TD, Costantini CO, Mehran R, Garcia E, et al. Relation between leukocyte count, myonecrosis, myocardial perfusion, and outcomes following primary angioplasty. Am J Cardiol 2007;99:1067-71.