The Importance of Magnesium Values in Patients With STEMI Admitted to the Emergency Department.

AIM: The aim of this study is to examine the relationship between initial magnesium (Mg) levels, electrocardiographic no-reflow, and long-term mortality in patients who underwent primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 111 patients with pPCI participated in the study. Magnesium and high-sensitive C-reactive protein (hs-CRP) were measured. The sum of ST-segment elevation was measured immediately before and 60 minutes after the restoration of coronary flow. The difference between the 2 measurements was taken as the amount of ST-segment resolution and defined as sum of ST-segment resolution (∑STR). The ∑STR <50% was determined as electrocardiographic sign of no-reflow phenomenon. After the patients were discharged, they were followed up for major adverse cardiac events for up to 51 months after discharge. RESULTS: Forty patients in the no-reflow group and 71 patients in the normal-flow group were included in the study. Magnesium value ≤1.87 mg/dL initially measured had 77% sensitivity and 59% specificity in predicting no-reflow on receiver operating characteristic curve analysis. In multivariate analyses, Mg (odds ratio [OR]: 0.01, <95% confidence interval [CI]: 0.01-0.12; P = .004), hs-CRP (OR: 1.06, <95% CI: 1.00-1.14; P = .05), left anterior descending artery lesion (OR: 6.66, <95% CI: 1.45-3.05; P = .01), and reperfusion time (OR: 1.01, <95% CI: 1.00-1.01; P = .03) were still independent predictors of electrocardiographic no-reflow, and only Mg (OR: 0.08, <95% CI: 0.01-1.03; P = .05) was still an independent predictor of long-term mortality. CONCLUSION: Serum Mg level is an independent predictor of electrocardiographic no-reflow and long-term mortality in patients with STEMI.

Comparison of the Framingham risk and SCORE models in predicting the presence and severity of coronary artery disease considering SYNTAX score.

OBJECTIVE: Although various risk stratification models are available and currently being used, the performance of these models in different populations is still controversial. We aimed to investigate the relation between the Framingham and SCORE models and the presence and severity of coronary artery disease, which is detected using the SYNTAX score. METHODS: The observational cross-sectional study population consisted of 227 patients with a mean age of 63.3±9.2 years. The patients were classified into low- and high-risk groups in the Framingham and SCORE models separately. Following coronary angiography, the patients were classified into SYNTAX=0 (SYNTAX score 0), low SYNTAX (SYNTAX score 1-22), and high SYNTAX (SYNTAX score>22) groups. The relation between the risk models and SYNTAX score was evaluated by student t test, Mann-Whitney U test or Kruskal-Wallis test and Receiver operating characteristic analysis were used to detect the discrimination ability in the prediction of SYNTAX score>0 and a high SYNTAX score. RESULTS: Both the Framingham and SCORE models were found to be effective in predicting the presence of coronary artery disease, and neither of the two models had superiority over each other [AUC=0.819 (0.767, 0.871) vs. 0.811 (0.757, 0.861), p=0.881]. Furthermore, both models were also effective in predicting the extent and severity of coronary artery disease [AUC=0.724 (0.656, 0.798) vs. 0.730 (0.662, 0.802), p=0.224]. When the subgroups were analyzed, the SCORE model was found to be better in predicting coronary artery disease extent and severity in subgroups of men and diabetics {[AUC=0.737 (0.668, 0.844) vs. 0.665 (0.560, 0.790), p=0.019], [AUC=0.733 (0.684, 0.798) vs. 0.680 (0.654, 0.750) p=0.029], respectively). CONCLUSION: In addition to their role in predicting cardiovascular events, the use of the Framingham and SCORE models may also have utility in predicting the extent and severity of coronary artery disease. The SCORE risk model has a slightly better performance than the Framingham risk model.

The impact of admission red cell distribution width on long-term cardiovascular events after primary percutaneous intervention: A four-year prospective study.

BACKGROUND: Red cell distribution width (RDW) is an indicator of erythrocyte in different size, and its prognostic value has been demonstrated in numerous cardiac and non-cardiac diseases. The purpose of this study was to evaluate the predictive value of RDW on the long- -term cardiovascular events in patients undergoing primary percutaneous coronary intervention (PCI). METHODS: Ninety-six consecutive patients (mean age 60.6 ± 12.5 years, 77.1% male) with ST-segment elevation myocardial infarction (STEMI), who were treated with primary PCI, were analyzed prospectively. Baseline RDW and high sensitive C-reactive protein (hs-CRP) were measured. The patients were followed up for major adverse cardiac events (MACE) for up to 48 months after discharge. RESULTS: There were 30 patients with long-term MACE (Group 1) and 66 patients without long-term MACE (Group 2). Age, admission RDW, hs-CRP and creatine kinase-MB levels, heart rate after PCI, previously used angiotensin converting enzyme inhibitor, left anterior descending artery lesion, and electrocardiographic no-reflow were higher in Group 1. Admission hemoglobin levels were lower in Group 1. An RDW level ≥ 13.85% measured on admission had 80% sensitivity and 64% specificity in predicting long-term MACE on receiver-operating characteristic curve analysis. In multivariate analyses, only admission RDW (HR 5.26, < 95% CI 1.71-16.10; p = 0.004) was an independent predictor of long-term MACE. CONCLUSIONS: A high baseline RDW value in patients with STEMI undergoing primary PCI is independently associated with increased risk for long term MACE.

The relationship between culprit artery and the clinical outcomes in patients undergoing primary percutaneous coronary intervention for inferior wall ST segment elevation myocardial infarction.

BACKGROUND: We observed the effect of culprit artery in patients undergoing primary percutaneous coronary intervention (PCI) caused by inferior wall ST elevation myocardial infarction (STEMI) during hospital stay and 6-month follow-ups. METHODS: After exclusion, 233 consecutive patients with inferior wall STEMI (mean age: 55.6±12.4 years) undergoing primary PCI were prospectively enrolled in this study. Patients were divided into two groups according to culprit artery: right coronary artery (RCA=group 1 [N.=187]) and left circumflex artery (LCX=group 2 [N.=46]). Patients were followed up for six months. RESULTS: Patients of both groups had similar risk factors such as age, sex, hypertension and diabetes mellitus. While there were more cases of right ventricular infarction (P=0.001), complete atrioventricular block (P=0.002) and proximal located lesions (P=0.002) in RCA group, there was less collateral circulation incidence in LCX group (P=0.04). Ratios of no-reflow and myocardial blush grade after primary PCI were similiar in both groups. There was no significant difference between groups associated with major adverse cardiac events (MACE), target-vessel revascularization and mortality ratios during hospital stay and 6-month follow-up period. CONCLUSIONS: The impact of RCA and LCX on MACE and cardiovascular mortality during hospital stay and the 6-month follow-up (mid-term) period are similar in patients on whom primary PCI was performed due to inferior wall STEMI.

Predictors of Prolonged In-Hospital Stay After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction.

Health care costs increase with prolonged in-hospital stays. Many factors influence the length of stay for patients with ST-elevation myocardial infarction (STEMI). In this study, we aimed to determine the differences between long-stay and early discharged patients with STEMI. For this retrospective study, a total of 2486 consecutive patients with STEMI (mean age: 56.2 ± 11.7 years, 16.5% female) who had undergone primary percutaneous coronary intervention (pPCI) were enrolled. Patients were divided into 2 groups based on mean in-hospital stay: <6 days and ≥6 days. Anterior STEMI (odds ratio [OR]: 1.61, 95% confidence interval [CI]: 1.02-2.54; P = 0.03), angiographic failure (OR: 2.89, 95% CI: 1.19-7.01; P = .01), and peripheral vascular complications (PVCs; OR: 4.18, 95% CI: 1.16-15.03; P = .02) were found to be independent predictors of ≥6-day in-hospital stay. The incidence of long-term total mortality and composite end point for death, reinfarction, and target vessel revascularization were significantly higher in ≥6-day in-hospital stay patients. Anterior STEMI, angiographic failure, and PVCs were found to be independently associated with prolonged in-hospital stay for patients with STEMI following pPCI.

Relationship between red cell distribution width and stroke in patients with stable chronic heart failure: a propensity score matching analysis.

AIM: We aimed to investigate the association between baseline red cell distribution width (RDW) level and the risk of stroke in patients with heart failure (HF). METHODS: A total of 153 consecutive patients with HF (New York Heart Association [NYHA] I-III and left ventricular ejection fraction of <40%) were included in this prospective study. All the patients were followed up for 1 year, and during this period the cerebrovascular disease was questioned. RESULTS: In matched population, using propensity score matching comparing patients with HF having stroke with patients without stroke, we found significantly increased basal RDW and serum uric acid. The receiver-operating characteristic curves of RDW for predicting stroke are performed. An RDW ≥ 15.2% measured on admission had 87% sensitivity and 74% specificity in predicting stroke in patients with HF (area under the curve: 0.923, 95% confidence interval: 0.852-0.994, P < .001). CONCLUSION: In conclusion, this study demonstrated that RDW may be important hematological indices for stroke in patients with HF using propensity score analysis.

The association between coronary slow flow and platelet distribution width among patients with stable angina pectoris.

INTRODUCTION: Coronary slow flow (CSF) is an angiographic phenomenon characterised by the delay of distal vessel opacification in the absence of significant stenosis of the epicardial coronary arteries. Some of the factors playing a role in CSF pathophysiology are increased thrombogenic activity and inflammation. AIM: To examine the relationship between platelet distribution width (PDW) and CSF. MATERIAL AND METHODS: Taking into consideration the exclusion criteria, 136 patients with CSF and 152 patients with normal coronary angiographies (control group) were included in the study. The association between thrombolysis infarction frame count (TFC) in myocardial and laboratory and other clinical parameters were evaluated. RESULTS: The stated parameters were significantly higher in the group with CSF than in the normal coronary angiography group (control group). The PDW (16.6 ±0.7 vs. 16.4 ±0.6, p = 0.002), neutrophil lymphocyte ratio (NLR) (3.1 ±3.4 vs. 2.4 ±1.1, p = 0.027), haemoglobin (Hb) (14.1 ±1.3 vs. 14.7 ±1.1, p < 0.001), and red cell distribution width (RDW) (13.6 ±0.7 vs. 14.1 ±2.8, p = 0.026) were significantly higher in the CSF group than in the control group. Moreover, our study showed that PDW > 16.15 and Hb > 1 3.75 were predictors of the presence of CSF with sensitivities of 83% and 73% and specificities of 40% and 42%, respectively. CONCLUSIONS: This study has demonstrated that compared to normal coronary flow, PDW, Hb, NLR, and RDW are significantly higher in CSF patients. We believe that further studies are needed to clarify the role of PDW and Hb in patients with CSF.

The independent association of plateletcrit with long-term outcomes in patients undergoing primary percutaneous coronary intervention.

PURPOSE: Platelets play a key role in the genesis of thrombosis. Plateletcrit (PCT) provides complete information on total platelet mass. The relationship between PCT values and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary angioplasty is not known. We sought to determine the effect of PCT values on the outcomes of primary angioplasty for STEMI. METHODS: Overall, 2572 consecutive STEMI patients (mean age, 56.6±11.8 years) undergoing primary percutaneous coronary intervention were enrolled retrospectively into the present study. Plateletcrit at admission was measured as part of the automated complete blood count. Patients were classified into 2 groups: high PCT (>0.237, n=852) and nonhigh PCT (<0.237, n=1720). Clinical characteristics and in-hospital and long-term (median, 21 months) outcomes of primary angioplasty were analyzed. RESULTS: A higher in-hospital shock rate was observed among patients with high PCT values compared with those with nonhigh PCT values (6.5 vs 3.8%, respectively; P=.003). The long-term cardiovascular prognosis was worse for patients with high PCT values (Kaplan-Meier, log-rank test; P=.007). We used Cox proportional hazard models to examine the association between PCT and adverse clinical outcomes. High PCT values were also an independent predictor of cardiovascular mortality (hazard ratio, 1.85; 95% confidence interval, 1.061-3.22; P=.03). CONCLUSION: High PCT values on admission are independently associated with long-term adverse outcomes in patients with STEMI who undergo primary angioplasty.

Clinical importance of hyperemic coronary blood flow (thrombolysis in myocardial infarction-intravenous flow) after primary percutaneous coronary intervention.

We aimed to investigate clinical, demographic and angiographic factors associated with hyperemic coronary blood flow (HCBF) and the relation of HCBF with mortality at 30 days. Our study included 809 consecutive patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention (PCI). We divided corrected thrombolysis in myocardial infarction (TIMI) frame count (TFC) values into three tertiles: less than 14, 14-28 and more than 28. Corrected TFC less than 14 was defined as HCBF or TIMI intravenous flow. The primary end-point of the present study was all-cause mortality within 30 days. Among the HCBF group (n = 58), the patients with poor myocardial perfusion demonstrated the highest mortality rate within the 30-day follow-up period (33%). Low TIMI myocardial perfusion grade, history of no smoking, left ventricular ejection fraction (LVEF), and high Killip status and low LVEF were found to be independently associated with 1-month all-cause mortality. The present study showed that HCBF after primary PCI has a high 30-day mortality when associated with impaired reperfusion.

Association of P wave dispersion and left ventricular diastolic dysfunction in non-dipper and dipper hypertensive patients.

OBJECTIVE: Objective of this study was to investigate the correlation between P wave dispersion and left ventricular diastolic function, which are associated with the increased cardiovascular events in patients with dipper and non-dipper hypertensive (HT). METHODS: Eighty sex and age matched patients with dipper and non-dipper HT, and 40 control subject were included in this observational cross-sectional study. P wave dispersion was measured through electrocardiography obtained during the admission. The left ventricular LV ejection fraction was measured using the modified Simpson's rule by echocardiography. In addition, diastolic parameters including E/A rate, deceleration time (DT) and isovolumetric relaxation time (IVRT) were recorded. Independent samples Bonferroni, Scheffe and Tamhane tests and correlation test (Spearman and Pearson) were used for statistical analysis. RESULTS: P wave dispersion was found to be significantly increased in the non-dipper than in the dipper group (56.0±5.6 vs. 49.1±5.3, p<0.001). Pmax duration was found significantly higher (115.1±5.6 vs. 111.1±5.8, p=0.003) and Pmin duration significantly lower (59.0±5.6 vs. 62.3±5.3, p=0.009) in the non-dippers. Correlation analysis demonstrated presence of moderate but significant correlation between P-wave dispersion and left ventricular mass index (r=0.412, p=0.011), IVRT (r=0.290 p=0.009), DT (r=0.210, p=0.052) and interventricular septum thickness (r=0.230 p=0.04). CONCLUSION: P wave dispersion and P Max were found to be significantly increased and P min significantly decreased in the non-dipper HT patients compared to the dipper HT patients. P-wave dispersion is associated with left ventricular dysfunction in non-dipper and dipper HT.

Relation of ABO blood groups to coronary lesion complexity in patients with stable coronary artery disease.

OBJECTIVE: We aimed to investigate the relationship between ABO blood groups and complexity of coronary lesions assessed by SYNTAX score (SS) in stable coronary artery disease (CAD) patients. METHODS: Our cross-sectional and observational study population consisted of 559 stable CAD patients. From all patients, ABO blood group was determined and the SS was calculated as low SYNTAX score (0-22), intermediate SYNTAX (23-32) score and high SYNTAX score (>32). Statistical analysis was performed using Student's t-test or Mann-Whitney U test, ANOVA, or Kruskal-Wallis test and chi-square test. Multiple logistic regression analysis was used to identify the independent predictors of high SS. RESULTS: The analysis between the SS tertiles revealed that the frequency of non-O blood group was significantly higher in the upper SS tertiles (56.2% vs. 75.9 vs. 80.2%, p<0.05). However, the frequencies of Rh types were similar in all tertiles. Multiple logistic regression analysis was applied for determining the predictors of high SS. Accordingly, non-O blood group (OR: 2.68, 95% CI 1.65-4.35, p<0.001), LV-EF (OR: 0.93, 95% CI 0.91-0.95, p<0.001), LDL(OR: 0.98, 95% CI 0.97-0.99, p<0.001), and e-GFR (OR: 0.99, 95% CI 0.98-0.98, p<0.001) were found to be the independent predictors of high SS. CONCLUSION: We showed that there were significant associations between ABO blood groups and complexity of angiographic CAD.

Predictive value of neutrophil to lymphocyte ratio in clinical outcomes of non-ST elevation myocardial infarction and unstable angina pectoris: a 3-year follow-up.

We sought to determine the prognostic value of neutrophil to lymphocyte ratio (NLR) in non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP). A total of 308 (mean age 59.22 ± 11.93) patients with NSTEMI and UAP were prospectively evaluated. The study population was divided into tertiles based on admission NLR values. The patients were followed for clinical outcomes for up to 3 years after discharge. In the Kaplan-Meier survival analysis, 3-year mortality was 21.6% in patients with high NLR versus 3% in the low-NLR group (P < .001). In a receiver-operating characteristic curve analysis, an NLR value of 3.04 was identified as an effective cut point in NSTEMI and UAP of a 3-year cardiovascular mortality (area under curve [AUC] = 0.86, 95% confidence interval [CI] 0.8-0.92). An NLR value >3.04 yielded a sensitivity of 79% and specificity of 71%. Admission NLR is the strong and independent predictor of a 3-year cardiovascular mortality in patients with NSTEMI and UAP.

Predictive value of elevated neutrophil to lymphocyte ratio in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction.

OBJECTIVES: The neutrophil to lymphocyte ratio (NLR) has been investigated as a new predictor for cardiovascular risk. Admission NLR would be predictive of adverse outcomes after primary angioplasty for ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 2410 patients with STEMI undergoing primary angioplasty were retrospectively enrolled. The study population was divided into tertiles based on the NLR values. A high NLR (n = 803) was defined as a value in the third tertile (>6.97), and a low NLR (n = 1607) was defined as a value in the lower 2 tertiles (≤6.97). RESULTS: High NLR group had higher incidence of inhospital and long-term cardiovascular mortality (5% vs 1.4%, P < .001; 7% vs 4.8%, P = .02, respectively). High NLR (>6.97) was found as an independent predictor of inhospital cardiovascular mortality (odds ratio: 2.8, 95% confidence interval: 1.37-5.74, P = .005). CONCLUSIONS: High NLR level is associated with increased inhospital and long-term cardiovascular mortality in patients with STEMI undergoing primary angioplasty.

Relation of neutrophil to lymphocyte ratio with the presence and severity of stable coronary artery disease.

OBJECTIVES: We examined the association between neutrophil to lymphocyte ratio (NLR) and the complexity of coronary artery disease assessed by SYNTAX score (SS). METHODS: The study population included patients with chest pain who had undergone coronary angiography for stable angina pectoris. Patients were classified depending on whether the SS was 0 or SS > 0. RESULTS: Left ventricular ejection fraction, estimated glomerular filtration rate, and NLR were found to be the independent predictors of high SS in multivariate analysis. The area under the receiver-operating curve of NLR was 0.72 (0.65-0.80, P < .001) for predicting high SS. The optimal cutoff value of NLR to predict high SS was 2.7 (sensitivity of 72% and a specificity of 61%). There was a significant correlation between NLR ratio and continuous SS (r = .552, P < .001). CONCLUSION: The NLR is a readily measurable systemic inflammatory marker and is associated with both the presence and the complexity of coronary artery disease.

Rosuvastatin versus atorvastatin to prevent contrast induced nephropathy in patients undergoing primary percutaneous coronary intervention (ROSA-cIN trial).

AIM: We aimed to compare the incidence of contrast-induced nephropathy (CIN) between atorvastatin versus rosuvastatin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary coronary angioplasty. METHODS: One hundred ninety-two consecutive patients, who underwent primary percutaneous intervention (p-PCI) with the diagnosis of STEMI, were included in the study. The patients were randomized to take atorvastatin 80 mg (n=98) or rosuvastatin 40 mg (n= 94) before the procedure. Biochemical and complete blood count measurements were done at baseline and at 48 hours following admission. RESULTS: The incidence of CIN was 8.9% (n= 17) in the entire groups. The analysis performed between the statin groups revealed no statistical difference in any of the renal dysfunction indicators [baseline creatinine, baseline estimated glomerular filtration rate (eGFR), creatinine at 48 h, eGFR at 48 h, difference between baseline and 48 h creatinine, the per cent increase in the creatinine at 48 hours relative to basal creatinine]. In STEMI patients undergoing primary PCI, only the amount of the contrast agent administered was determined to be an independent predictor for CIN (OR and 95% CI: 1.08 (1.03- 1.13), P< or = 0.001). Left ventricular ejection fraction exhibited borderline statistical significance (OR and 95% CI: 0.88 (0.77-1.01), P= 0.07). CONCLUSION: Atorvastatin and rosuvastatin had similar efficacy in preventing CIN in patients with STEMI undergoing P-PCI.

Association of neutrophil to lymphocyte ratio with presence of isolated coronary artery ectasia.

OBJECTIVES: Coronary artery ectasia (CAE) has been defined as a dilated artery luminal diameter that is at least 50% greater than the diameter of the normal portion of the artery. Isolated CAE is defined as CAE without significant coronary artery stenosis and isolated CAE has more pronounced inflammatory symptoms. Neutrophil to lymphocyte ratio (NLR) is widely used as a marker of inflammation and an indicator of cardiovascular outcomes in patients with coronary artery disease. We examined a possible association between NLR and the presence of isolated CAE. STUDY DESIGN: In this study, 2345 patients who underwent coronary angiography for suspected or known ischemic heart disease were evaluated retrospectively. Following the application of exclusion criteria, our study population consisted of 81 CAE patients and 85 age- and gender-matched subjects who proved to have normal coronary angiograms. Baseline neutrophil, lymphocyte and other hematologic indices were measured routinely prior to the coronary angiography. RESULTS: Patients with angiographic isolated CAE had significantly elevated NLR when compared to the patients with normal coronary artery pathology (3.39 ± 1.36 vs. 2.25 ± 0.58, p<0.001). A NLR level >= 2.37 measured on admission had a 77% sensitivity and 63% specificity in predicting isolated CAE at ROC curve analysis. In the multivariate analysis, hypercholesterolemia (OR=2.63, 95% CI 1.22-5.65, p=0.01), obesity (OR=3.76, 95% CI 1.43-9.87, p=0.007) and increased NLR (OR=6.03, 95% CI 2.61-13.94, p<0.001) were independent predictors for the presence of isolated CAE. CONCLUSION: Neutrophil to lymphocyte ratio is a readily available clinical laboratory value that is associated with the presence of isolated CAE.

The impact of NT-proBNP on admission for early risk stratification of patients undergoing primary percutaneous coronary intervention.

BACKGROUND: Incompleted ST segment resolution (STR) after primary percutaneous coronary intervention (PCI) is associated with worse clinical outcomes. AIM: To investigate the association between plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) levels on admission and STR after reperfusion, in a patient with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. METHODS: After exclusion, 81 consecutive patients with STEMI (mean age: 61.3 ± 13.4 years) undergoing primary PCI were prospectively enrolled in this study. Patients were divided into two groups according to ST-segment resolution: ΣSTR < 50%, the no-reflow phenomenon positive (+) group (n = 20), and ΣSTR ≥ 50%, the no-reflow phenomenon negative (-) group (n = 61). Patients were followed up for six months. RESULTS: The no-reflow phenomenon (+) group had similar baseline cardiovascular risk factors (e.g. age, sex, hypertension, diabetes mellitus) but higher mid-term mortality (25% vs. 6.5%, p = 0.02) than the no-reflow phenomenon (-) group. The frequency of anterior MI in the no-reflow phenomenon (+) group was higher (75%, p = 0.02). NT-proBNP levels on admission were higher in the no-reflow phenomenon (+) group (p = 0.001). A NT-proBNP level ≥ 563.4 pg/mL measured on admission had a 72.7% sensitivity and 72.9% specificity in predicting no-reflow phenomenon at ROC curve analysis. At multivariate analysis, anterior MI, high NT-proBNP levels, prolonged chest pain-to-reperfusion time (> 6 h) and post-TIMI-3 flow were independent predictors of no-reflow phenomenon after primary PCI. CONCLUSIONS: Plasma NT-proBNP level on admission is a strong and independent predictor of no-reflow phenomenon following primary PCI and mid-term cardiovascular mortality in patients with STEMI.