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

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 12h following the onset of symptoms were enrolled. Serum PCT levels were measured on admission. Patients (age: 5913 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) mu g/l, P<0.001]. In receiver operating characteristics curve analysis, the cut-off value of PCT was 0.066 mu g/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 mu g/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.