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To evaluate the diagnostic value of the selected emerging biomarkers in predicting the no-reflow phenomenon among patients presenting with STEMI undergoing primary PCI. These biomarkers include:
HbA1c/C-peptide ratio
Albumin-bilirubin (ALBI) score.
Neutrophil/HDL ratio
The no-reflow phenomenon is a well-recognized complication following primary percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI). Despite successful opening of the occluded coronary artery, impaired myocardial perfusion may persist, significantly increasing the risk of adverse cardiovascular outcomes.
Recent research has identified several novel biomarkers that may help predict the risk of no-reflow. These include metabolic, inflammatory, and hepatic-renal markers that reflect the systemic milieu of patients with acute coronary syndromes. Among these emerging biomarkers, the following are of particular interest:
This study aims to validate the prognostic value of these biomarkers in predicting the no-reflow phenomenon in STEMI patients undergoing primary PCI.
To validate the clinical utility of selected emerging biomarkers in predicting the no-reflow phenomenon among patients presenting with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Thus , our objective is to investigate :
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| No-Reflow Group | STEMI patients undergoing primary PCI who develop angiographic no-reflow, defined as final TIMI flow ≤2 and/or Myocardial Blush Grade (MBG) 0-1 after stent deployment in the absence of mechanical obstruction (no dissection, spasm, residual thrombus, or significant residual stenosis). Planned enrollment: 56. |
| |
| Reflow Group | STEMI patients undergoing primary PCI who achieve successful epicardial and microvascular reperfusion, defined as final TIMI 3 flow and MBG 2-3 after PCI. Planned enrollment: 56. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| HbA1c/C-peptide ratio Albumin-bilirubin (ALBI) score. Neutrophil/HDL ratio | Diagnostic Test |
|
| Measure | Description | Time Frame |
|---|---|---|
| HbA1c/C-peptide ratio predictive accuracy for no-reflow phenomenon | Diagnostic accuracy of HbA1c/C-peptide ratio for predicting the no-reflow phenomenon in STEMI patients undergoing primary PCI, assessed by area under the ROC curve (AUC). | Baseline (prior to PCI) |
| Albumin-bilirubin (ALBI) score predictive accuracy for no-reflow phenomenon | Diagnostic accuracy of ALBI score for predicting the no-reflow phenomenon in STEMI patients undergoing primary PCI, assessed by area under the ROC curve (AUC). | Baseline (prior to PCI) |
| Neutrophil/HDL ratio predictive accuracy for no-reflow phenomenon | Diagnostic accuracy of neutrophil/HDL ratio for predicting the no-reflow phenomenon in STEMI patients undergoing primary PCI, assessed by area under the ROC curve (AUC). | Baseline (prior to PCI) |
| Measure | Description | Time Frame |
|---|---|---|
| Correlation of HbA1c/C-peptide ratio, Neutrophil-to-HDL ratio, and Albumin-Bilirubin (ALBI) score with in-hospital major adverse cardiovascular events (MACE). | HbA1c/C-peptide ratio (unit: ratio, measured from immunoassay-derived HbA1c and C-peptide levels), Neutrophil-to-HDL ratio (unit: ratio, derived from complete blood count and serum HDL measurement), and Albumin-Bilirubin (ALBI) score (unit: score, calculated from serum albumin [g/dL] and total bilirubin [mg/dL]) will be correlated with the incidence of in-hospital major adverse cardiovascular events (MACE) [unit: % of patients experiencing MACE]. |
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Inclusion Criteria:
Exclusion Criteria:
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The study will include patients presenting with ST-segment elevation myocardial infarction (STEMI) who are admitted to the [specify hospital/center] and undergo primary percutaneous coronary intervention (PCI).
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Hossam E. A. Abdelhafiz | Contact | 00201143999651 | Hossamalaa203040@gmail.com | |
| Marwan S. Mahmoud | Contact |
| Name | Affiliation | Role |
|---|---|---|
| Hossam H. Ali | Principal Investigator |
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| ID | Term |
|---|---|
| D009203 | Myocardial Infarction |
| D054318 | No-Reflow Phenomenon |
| ID | Term |
|---|---|
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |
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|
| Baseline to hospital discharge. |
| Correlation of HbA1c/C-peptide ratio, Neutrophil-to-HDL ratio, and Albumin-Bilirubin (ALBI) score with 1-month major adverse cardiovascular events (MACE). | HbA1c/C-peptide ratio (unit: ratio, measured from immunoassay-derived HbA1c and C-peptide levels), Neutrophil-to-HDL ratio (unit: ratio, derived from complete blood count and serum HDL measurement), and Albumin-Bilirubin (ALBI) score (unit: score, calculated from serum albumin [g/dL] and total bilirubin [mg/dL]) will be correlated with the incidence of major adverse cardiovascular events (MACE) at 1-month follow-up [unit: % of patients experiencing MACE]. | Baseline to 1-month follow-up. |
| D007238 |
| Infarction |
| D007511 | Ischemia |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009336 | Necrosis |