Predictors of preinterventional patency of infarct-related artery in patients with ST-segment elevation myocardial infarction: Importance of neutrophil to lymphocyte ratio and uric acid level.

BACKGROUND: Patients with ST-segment elevation myocardial infarction (STEMI) and a patent infarct-related artery (IRA) experience lower mortality and better clinical outcome, but little is known about the predictors of IRA patency before primary percutaneous coronary intervention (PCI) in the setting of STEMI.

OBJECTIVE: To assess possible predictors of patency of IRA before primary PCI in patients with STEMI.

METHODS: A total of 880 patients with STEMI undergoing primary PCI were prospectively included (646 male, 234 female; mean [± SD] age 58.5±12.4 years). Blood samples were obtained on admission to investigate biochemical markers. Preinterventional thrombolysis in myocardial infarction (TIMI) flow was assessed in all patients. The patients were divided into two groups according to the pre-PCI TIMI flow as impaired flow group (TIMI flow 0, 1 and 2) and normal flow group (TIMI flow 3). Transthoracic echocardiography was performed in all patients.

RESULTS: Eighty-three (9.43%) patients had pre-PCI TIMI 3 flow in IRA. Uric acid levels and neutrophil to lymphocyte (N to L) ratio in the normal flow group were lower than in the impaired flow group (P<0.001 for both). However, ejection fraction (EF) was higher in the normal flow group than in the impaired flow group. Multivariate logistic regression analysis showed that IRA patency was independently associated with serum uric acid level (β 0.673 [95% CI 0.548 to 0.826]; P<0.001), N to L ratio (β 0.783 [95% CI 0.683 to 0.897]; P<0.001) and EF (β 1.033 [95% CI 1.006 to 1.061]; P=0.016).

CONCLUSION: Serum uric acid level, N to L ratio and EF are independent predictors of the pre-PCI patency of IRA in patients with STEMI undergoing primary PCI.