Serum sP-Selectin level and brachial artery flow mediated dilation as predictors of no reflow in patients with ST segment elevation myocardial infarction undergoing primary PCI

Abstract

No-reflow has been variably defined. In the setting of percutaneous coronary intervention (PCI) it is best defined as inadequate myocardial perfusion in the infarct related artery without evidence of mechanical epicardial vessel obstruction. Angiographic no-reflow is defined as less than Thrombolysis in Myocardial Infarction (TIMI) 3 flow and it occurs in around 2% of all PCI cases .(3) Studies showed that no reflow was associated with high incidence of major adverse cardiac events following primary PCI .(1,2,4) Several trails tried to address the clinical and procedural predictors of no reflow . (5) , others tried to find correlation between the different biomarkers and no reflow; Thus several therapeutic and interventional procedures could be applied to prevent the occurrence of no reflow. (6) P-selectin is an adhesion molecule located in the platelet alpha granule and Weibel-Palade body of endothelial cells. P-selectin plays a key role in diseases associated with injury and arterial thrombosis. Increased expression of P-selectin is observed in coronary artery disease, acute myocardial infarction, stroke, and peripheral arterial diseases. (7) Endothelial dysfunction as an integrating index of the risk factor burden and genetic susceptibility is an early marker of atherothrombotic disease. Flow-mediated dilation (FMD) of the peripheral conduit arteries is one of the most widely used tests of endothelial function. (8) There are no enough data about the use of the serum P-selectin level and the brachial artery flow mediated dilation to predict patients with high thrombotic burden and hence the incidence of no reflow in patients with STEMI who undergo primary PCI We attempted to investigate the predictive value of serum sP-selectin and endothelial dysfunction in patients with STEMI undergoing primary percutaneous coronary intervention (PCI) to address patients with high incidence of no reflow We thus evaluated the prognostic performance , clinical and angiographic correlates of sP-selectin and brachial artery flow mediated dilation , among patients