Serum B-type natriuretic peptide on admission can predict the 'no-reflow' phenomenon after primary drug-eluting stent implantation for ST-segment elevation myocardial infarction

Young Hoon Jeong, Won Jang Kim, Duk Woo Park, Bong Ryong Choi, Seung Whan Lee, Young Hak Kim, Cheol Whan Lee, Myeong Ki Hong, Jae Joong Kim, Seong Wook Park, Seung Jung Park

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Background: The angiographic 'no-reflow' phenomenon after primary percutaneous coronary intervention (PPCI) is associated with a poor short-term and long-term clinical prognosis of ST-elevation myocardial infarction (STEMI). Although the increasing use of primary drug-eluting stent (DES) deployment for STEMI resulted in reduced adverse clinical outcomes, the prevalence of no-reflow has been unchanged. The purpose of our study was to evaluate the predictors for no-reflow for STEMI and identify such high-risk patients in the DES era. Methods: The study prospectively enrolled 300 consecutive STEMI patients (80% men; 57 ± 11 years) who underwent PPCI within 12 h of symptom onset. The no-reflow phenomenon was defined as an angiographic outcome of Thrombolysis In Myocardial Infarction (TIMI) grade < 3 without accompanying mechanical factors. Results: Compared to normal reflow patients, no-reflow patients (n = 15, 5% of the total study population) were older (64 ± 13 vs. 57 ±11 years; P = 0.019), transferred to hospital later (7.1 ± 3.2 vs. 4.5 ± 3.8 h; P = 0.011), and had a higher TIMI risk score (5.5 ± 2.0 vs. 3.8 ± 2.2; P = 0.004). B-type natriuretic peptide (BNP), high sensitivity C-reactive protein, and serum creatinine levels were higher in the no-reflow than the normal reflow group. Multivariate analysis (including clinical, angiographic and procedural variables with a P < 0.2 in univariate analysis) showed that high BNP level on admission was the only independent predictor of no-reflow. The area under the receiver-operating characteristics curve analysis value for BNP was 0.786. BNP ≥ 90 pg/ml showed a sensitivity of 80% and a specificity of 70% for predicting no-reflow after primary DES implantation (OR 14.953, 95% CI 3.131-71.419, P = 0.001). Conclusions: Angiographic 'no-reflow' phenomenon after primary DES implantation for STEMI can be predicted by BNP levels on admission. BNP-guided approach may be useful in identifying patients at high risk of the no-reflow phenomenon after primary stenting.

Original languageEnglish
Pages (from-to)175-181
Number of pages7
JournalInternational Journal of Cardiology
Issue number2
Publication statusPublished - 2010 May 28


All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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