The association of serum procalcitonin level with the no-reflow phenomenon after a primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction.

ABSTRACT

OBJECTIVE: The no-reflow phenomenon is associated with adverse outcomes in patients with acute ST-elevation myocardial infarction (STEMI) treated by a primary percutaneous coronary intervention (PPCI). Procalcitonin (PCT) is a marker of systemic inflammatory states and an elevated serum PCT concentration is related to an increased risk of cardiovascular events. We aimed to assess whether serum PCT level at admission is an independent predictor of no-reflow in patients with STEMI treated with PPCI. PATIENTS AND METHODS: Between November 2012 and December 2014, 501 consecutive patients with STEMI who underwent PPCI within the first 12 h following the onset of symptoms were enrolled. Serum PCT levels were measured on admission. Patients (age 59±13 years, 73.5% men) were divided into the two groups no-reflow and reflow. The no-reflow phenomenon was defined as final Thrombolysis In Myocardial Infarction flow grade less than 3 after PPCI. RESULTS: No-reflow was diagnosed in 91 (18.2%) patients. PCT levels were significantly higher in patients who developed no-reflow than in those who did not [0.102 (0.063-0.247) vs. 0.042 (0.020-0.076) µg/l, P<0.001]. In receiver operating characteristics curve analysis, the cut-off value of PCT was 0.066 µg/l for the prediction of no-reflow (area under the curve 0.776, 95% confidence interval 0.720-0.831, P<0.001, sensitivity 73%, specificity 70%). On multivariate analysis, serum PCT (>0.066 µg/l) value was an independent predictor of no-reflow (odds ratio 3.377, 95% confidence interval 1.572-7.255, P=0.002), together with early patency of culprit artery (P=0.046), Killip class more than or equal to 2 at presentation (P=0.028), and total stent length (P=0.004). CONCLUSION: Increased admission PCT level is associated independently with no-reflow after PPCI in STEMI patients.