The relation between platelet/lymphocyte ratio and the occurrence of no reflow in patients with ST-segment elevation myocardial infarction managed by primary percutaneous coronary intervention

• Main Authors: Ahmed Mohamed El Missiri, Mohamed Rashad Awad, Sameh Maamoun Shaheen
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2021-01-01
• Series: International Journal of the Cardiovascular Academy
• Subjects: lymphocyte; myocardial infarction; no-reflow; percutaneous coronary intervention; platelet; primary
• Online Access: http://www.ijcva.com/article.asp?issn=2405-8181;year=2021;volume=7;issue=1;spage=2;epage=8;aulast=El
• ISSN: 2405-8181; 2405-819X

Introduction: No reflow phenomenon following primary percutaneous coronary intervention (PCI) is a strong predictor of mortality. Platelet/lymphocyte ratio (PLR) is an indicator of long-term outcome in ischemic heart disease patients. The aim of this study was to assess the relation between PLR measured on admission and the occurrence of no-reflow phenomenon in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) managed by primary PCI. Methods: This was a prospective study including 100 patients with acute STEMI managed by primary PCI. Venous blood samples were obtained on admission to assess hemoglobin level, platelet count, and lymphocyte count. Thrombolysis in myocardial infarction (TIMI) flow grade, myocardial blush grade (MBG), and TIMI thrombus scale were assessed immediately following revascularization. During hospital stay, peak creatinine kinase MB fraction (CK-MB) was recorded, and transthoracic echocardiography was performed to assess left ventricular ejection fraction (LVEF). Results: Patients were divided into two groups based on the TIMI flow grade following PCI: Normal coronary flow group (TIMI 3 flow grade, n = 71) and reduced coronary flow (no-reflow) group (TIMI 0, 1, and 2, n = 29). There was a larger proportion of diabetic patients in the no-reflow group (P = 0.028). In addition, patients in the no-reflow group had a more advanced Killip class on presentation (P = 0.001), a lower LVEF (P < 0.0001), and a significantly higher PLR 213.66 ± 115.35 versus 122.81 ± 59.82 (P < 0.0001). PLR was significantly higher in patients with lower TIMI flow grade and lower MBG (P < 0.0001 for both). A significant correlation existed generally between PLR and peak CK-MB more in the no-reflow group (r = 0.471, P = 0.01). A PLR more than 108.08 predicted no-reflow with a sensitivity of 53%, a specificity of 86%, PPV of 80.%, and a NPV of 43.1% (AUC = 0.73). PLR was found to be an independent predictor of no-reflow multivariate regression analysis for predictors of no-reflow (ß = 0.0023, 9% CI = 0.0014–0.0032, P < 0.0001). Conclusions: PLR measured on admission is elevated in patients with STEMI who develop no-reflow during primary PCI. PLR is an independent predictor of no-reflow in such patients.