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Association between kaolin-induced maximum amplitude and slow-flow/no-reflow in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention

  • Author Footnotes
    1 These authors contributed equally to the work.
    Qing Li
    Footnotes
    1 These authors contributed equally to the work.
    Affiliations
    Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
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  • Author Footnotes
    1 These authors contributed equally to the work.
    Enmin Xie
    Footnotes
    1 These authors contributed equally to the work.
    Affiliations
    China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
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  • Yimin Tu
    Affiliations
    China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
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  • Yaxin Wu
    Affiliations
    Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
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  • Ziyu Guo
    Affiliations
    Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
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  • Peizhao Li
    Affiliations
    Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
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  • Yike Li
    Affiliations
    China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
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  • Xiaozhai Yu
    Affiliations
    China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
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  • Zixiang Ye
    Affiliations
    Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
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  • Changan Yu
    Affiliations
    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
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  • Yanxiang Gao
    Correspondence
    Correspondence to: Y. Gao, Department of Cardiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghua Dongjie, Beijing 100029, China.
    Affiliations
    Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
    Search for articles by this author
  • Zheng Jingang
    Correspondence
    Correspondence to: J. Zheng: Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing 100029, China.
    Affiliations
    Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China

    China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China

    Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to the work.

      Highlights

      • Kaolin-induced maximum amplitude was associated with the risk of slow flow/no-reflow in ST-segment elevation myocardial patients who were treated with percutaneous coronary intervention.
      • Kaolin-induced maximum amplitude and slow flow/no-reflow both predicted the long-term cardiovascular events risk.
      • A high kaolin-induced maximum amplitude level was associated with a significantly increased risk of ischemia events only in ST-segment elevation myocardial patients with slow-flow/no-reflow.

      Abstract

      Background

      ST-segment elevation myocardial infarction (STEMI) patients with a high thrombus burden have a relatively high slow-flow/no-reflow risk. However, the association between kaolin-induced maximum amplitude (MAthrombin) and slow-flow/no-reflow has been scarcely explored.

      Methods

      STEMI patients treated with primary percutaneous coronary intervention (PCI) were retrospectively enrolled from January 2015 to December 2019 at China-Japan Friendship Hospital. MAthrombin levels were measured using thromboelastography before the PCI procedure. The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI) flow grade after primary PCI: the normal flow group (TIMI flow grade = 3) and slow-flow/no-reflow (TIMI flow grade ≤ 2). The logistic regression model and restricted cubic spline regression (RCS) were used to analyze the predictive value of MAthrombin for slow-flow/no-reflow. All patients were followed up after discharge and observed the adverse cardiovascular events between the two groups.

      Results

      A total of 690 patients were enrolled, with 108(15.7%) having slow-flow/no-reflow. The multivariate logistic regression model analysis showed that MAthrombin level was an independent risk factor for slow-flow/no-reflow. The RCS analysis showed a nonlinear relationship between MAthrombin levels and slow-flow/no-reflow. The cut-off value of MAthrombin levels for predicting slow-flow/no-reflow was 68 mm. During a median follow-up time of 4.4 years, slow-flow/no-reflow (hazard ratio 1.93, 95% confidence interval 1.27–2.93, P = 0.002) and MAthrombin levels (hazard ratio 1.06, 95% confidence interval 1.03–1.08, P < 0.001) were independent risk factors for predicting the long-term of adverse clinical cardiovascular events.

      Conclusion

      MAthrombin was an independent risk factor for predicting slow-flow/ no-reflow in STEMI patients who underwent primary PCI.

      Keywords

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