Mohamed Omar, Min Gyu Kang, Moon Ki Jung, Jong-Hwa Ahn, Jin-Sin Koh, Phil Iver Guevarra, Sang-Wook Kim, Udaya S Tantry, Paul A Gurbel, Jin-Yong Hwang, Young-Hoon Jeong
{"title":"st段抬高型心肌梗死患者“无回流现象”与高凝性的关系及其预后意义","authors":"Mohamed Omar, Min Gyu Kang, Moon Ki Jung, Jong-Hwa Ahn, Jin-Sin Koh, Phil Iver Guevarra, Sang-Wook Kim, Udaya S Tantry, Paul A Gurbel, Jin-Yong Hwang, Young-Hoon Jeong","doi":"10.1016/j.jacasi.2025.07.015","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Following percutaneous coronary intervention (PCI), the \"no-reflow phenomenon\" is associated with a worse outcome. However, it remains unclear how to prevent and treat this phenomenon during PCI.</p><p><strong>Objectives: </strong>This study aimed to evaluate the association between thrombogenicity profiles and \"no-reflow phenomenon\" during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI).</p><p><strong>Methods: </strong>From a real-world registry, we prospectively enrolled patients with STEMI who underwent primary PCI (n = 334). Thrombolysis In Myocardial Infarction flow grade was assessed at final angiography, and the \"no-reflow phenomenon\" was defined as Thrombolysis In Myocardial Infarction flow between 0 and 2. Thrombogenicity profiles were assessed with thromboelastography (TEG) and conventional hemostatic measurements.</p><p><strong>Results: </strong>Thirty-seven patients (11.1%) showed no-reflow after primary PCI. High platelet-fibrin clot strength (P-FCS: ≥ 68 mm) measured by TEG was significantly associated with an increased risk of post-PCI \"no-reflow phenomenon\" (OR: 2.611; 95% CI: 1.220-5.584; P = 0.010). The risk stratification with \"no-reflow phenomenon\" and \"high P-FCS phenotype\" appeared to be additive to predict the risk of 3-year clinical event (log-rank P < 0.001 across the groups). Patients with both \"no-reflow phenomenon\" and high P-FCS had a higher risk of adverse clinical events compared with normal-reflow subjects with low P-FCS (adjusted HR: 6.654; 95% CI: 2.678-16.530; P < 0.001).</p><p><strong>Conclusions: </strong>This study demonstrated a close relationship between heightened thrombogenicity (assessed by TEG P-FCS) with \"no-reflow phenomenon,\" and their additive prognostic implications after primary PCI in STEMI patients. Effective control of clot strength may reduce the risk of \"no-reflow phenomenon\" and improve clinical outcomes in these patients. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529).</p>","PeriodicalId":73529,"journal":{"name":"JACC. 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However, it remains unclear how to prevent and treat this phenomenon during PCI.</p><p><strong>Objectives: </strong>This study aimed to evaluate the association between thrombogenicity profiles and \\\"no-reflow phenomenon\\\" during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI).</p><p><strong>Methods: </strong>From a real-world registry, we prospectively enrolled patients with STEMI who underwent primary PCI (n = 334). Thrombolysis In Myocardial Infarction flow grade was assessed at final angiography, and the \\\"no-reflow phenomenon\\\" was defined as Thrombolysis In Myocardial Infarction flow between 0 and 2. Thrombogenicity profiles were assessed with thromboelastography (TEG) and conventional hemostatic measurements.</p><p><strong>Results: </strong>Thirty-seven patients (11.1%) showed no-reflow after primary PCI. High platelet-fibrin clot strength (P-FCS: ≥ 68 mm) measured by TEG was significantly associated with an increased risk of post-PCI \\\"no-reflow phenomenon\\\" (OR: 2.611; 95% CI: 1.220-5.584; P = 0.010). The risk stratification with \\\"no-reflow phenomenon\\\" and \\\"high P-FCS phenotype\\\" appeared to be additive to predict the risk of 3-year clinical event (log-rank P < 0.001 across the groups). Patients with both \\\"no-reflow phenomenon\\\" and high P-FCS had a higher risk of adverse clinical events compared with normal-reflow subjects with low P-FCS (adjusted HR: 6.654; 95% CI: 2.678-16.530; P < 0.001).</p><p><strong>Conclusions: </strong>This study demonstrated a close relationship between heightened thrombogenicity (assessed by TEG P-FCS) with \\\"no-reflow phenomenon,\\\" and their additive prognostic implications after primary PCI in STEMI patients. 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引用次数: 0
摘要
背景：经皮冠状动脉介入治疗（PCI）后，“无血流倒流现象”与较差的预后相关。然而，在PCI中如何预防和治疗这种现象尚不清楚。目的：本研究旨在评估st段抬高型心肌梗死（STEMI）患者首次PCI时血栓形成特征与“无回流现象”之间的关系。方法：从现实世界的注册表中，我们前瞻性地招募了接受初级PCI治疗的STEMI患者（n = 334）。在最终的血管造影中评估血栓溶解（Thrombolysis In Myocardial Infarction）血流等级，并将0 ~ 2级之间的血栓溶解（Thrombolysis In Myocardial Infarction）血流定义为“无回流现象”。通过血栓弹性成像（TEG）和常规止血测量评估血栓形成概况。结果：37例（11.1%）患者行PCI术后无血流循环。TEG测量的高血小板-纤维蛋白凝块强度（P- fcs:≥68 mm）与pci术后“无血流现象”风险增加显著相关（OR: 2.611; 95% CI: 1.220-5.584; P = 0.010）。“无回流现象”和“高P- fcs表型”的风险分层似乎是预测3年临床事件风险的加性因素（各组间log-rank P < 0.001）。“无回流现象”和高P- fcs的患者发生不良临床事件的风险高于低P- fcs的正常回流患者（校正HR: 6.654; 95% CI: 2.678 ~ 16.530; P < 0.001）。结论：该研究表明，STEMI患者初次PCI后血栓形成性升高（由TEG P-FCS评估）与“无回流现象”密切相关，其附加预后影响。有效控制凝块强度可降低“无回流现象”的发生风险，改善此类患者的临床预后。（庆尚道大学医院登记；NCT04650529）
Association and Prognostic Implications of "No-Reflow Phenomenon" and Hypercoagulability in Patients With ST-Segment Elevation Myocardial Infarction.
Background: Following percutaneous coronary intervention (PCI), the "no-reflow phenomenon" is associated with a worse outcome. However, it remains unclear how to prevent and treat this phenomenon during PCI.
Objectives: This study aimed to evaluate the association between thrombogenicity profiles and "no-reflow phenomenon" during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI).
Methods: From a real-world registry, we prospectively enrolled patients with STEMI who underwent primary PCI (n = 334). Thrombolysis In Myocardial Infarction flow grade was assessed at final angiography, and the "no-reflow phenomenon" was defined as Thrombolysis In Myocardial Infarction flow between 0 and 2. Thrombogenicity profiles were assessed with thromboelastography (TEG) and conventional hemostatic measurements.
Results: Thirty-seven patients (11.1%) showed no-reflow after primary PCI. High platelet-fibrin clot strength (P-FCS: ≥ 68 mm) measured by TEG was significantly associated with an increased risk of post-PCI "no-reflow phenomenon" (OR: 2.611; 95% CI: 1.220-5.584; P = 0.010). The risk stratification with "no-reflow phenomenon" and "high P-FCS phenotype" appeared to be additive to predict the risk of 3-year clinical event (log-rank P < 0.001 across the groups). Patients with both "no-reflow phenomenon" and high P-FCS had a higher risk of adverse clinical events compared with normal-reflow subjects with low P-FCS (adjusted HR: 6.654; 95% CI: 2.678-16.530; P < 0.001).
Conclusions: This study demonstrated a close relationship between heightened thrombogenicity (assessed by TEG P-FCS) with "no-reflow phenomenon," and their additive prognostic implications after primary PCI in STEMI patients. Effective control of clot strength may reduce the risk of "no-reflow phenomenon" and improve clinical outcomes in these patients. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529).
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