A New Inflammatory Marker of the No-reflow Phenomenon after Percutaneous Coronary Intervention (PCI) to Saphenous Venous in Patients with Coronary Artery Disease

Abstract

Background: Although numerous mechanisms regarding the no-reflow phenomenon (NRP) have been mentioned, they have not yet been fully elucidated. The NRP can impact the success rate even in a technically flawless percutaneous coronary intervention (PCI), which can be annoying. Before the procedure, there is no specific parameter or index that can assess a significant factor such as NRP that has a direct impact on the success of the PCI. Objectives: The present study aimed to evaluate the relationship between the systemic immune-inflammation index (SII) and NRP in patients who underwent PCI for saphenous vein graft (SVG). Methods: In this retrospective cohort study, 312 coronary artery bypass grafting (CABG) patients admitted to primary or elective SVG and those who underwent PCI between January 2014 and December 2021 were selected. Routine blood samples were taken from the patients at the time of admission, and SII was calculated as the ratio of the product of the total neutrophil count and the total platelet count to the lymphocyte count. The reperfusion rates after PCI were evaluated according to the thrombolysis in myocardial infarction (TIMI) grade flow and myocardial blush grade (MBG). Following the procedure, those with an angiographic TIMI flow grade of ≤ 2 or TIMI flow grade of 3 and a final MBG of < 2 were considered NRP. Results: The number of 85 patients (27.2%) were diagnosed with NRP. The SII and ST-elevation myocardial infarction were found to be independent predictors for NRP in multivariate logistic regression analysis (P<0.05). The SII predicted NRP with a sensitivity of 86% and a specificity of 80% (AUC: 0.866, 95% CI: 0.823 to 0.910, P<0.001) using a cut-off point of 13.45. Conclusion: The SII is an independent predictor that can be easily calculated from the whole blood test to predict no-reflow development, which is a frustrating complication in patients following the PCI to the saphenous vein. This predictor can enable us to pre-evaluate the non-operational reasons affecting the procedure's success.