The relationship between homocysteine and no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention

Abstract

Aims: The current study aimed to investigate the relationship between homocysteine and no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention (pPCI). Methods: Patients with ST-elevation myocardial infarctions (STEMI) who underwent pPCI in our center between May 01, 2022, and 20 August 2023 were included in this cross-sectional observational study. Patients were classified into two groups according to the occurrence of no-reflow during pPCI. Findings were compared between the two groups. Results: A total of 332 patients [male, 75 (%82.8)] with STEMI undergoing pPCI, were included. Among them, 35 (10.5%) patients developed no-reflow. Homocysteine level was significantly higher in the no-reflow(+) group than the no-reflow(-) group [median (IQR), 19.02 (16.11-22.23 vs. 12.45 (10.99-14.93), p=0.019]. According to the multivariate analysis, homocysteine level, TIMI risk score, and postdilatation were independent predictors of no-reflow occurrence [Odds Ratio (95% CI), 1.127 (1.042-1.218), p=0.003, 1.385 (1.157-1.659), p<0.001, and 2.396 (1.092-5.257), p=0.029, respectively]. Considering the ROC curve analysis for homocysteine predicting no-reflow, the area under the curve (AUC) was 0.714 with an optimal cut-off value of 14.1 (sensitivity of 71%, specificity 62%). Conclusion: Higher admission homocysteine levels were associated with no-reflow development in STEMI patients during pPCI. Higher levels of homocysteine may identify a subset of patients at a higher risk of no-reflow development during pPCI.

Keywords

• no-reflow
• homocysteine
• STEMI
• PCI

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