الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
One of the major causes of mortality and morbidity is acute
myocardial infarction. Those patients are liable to develop many
complications as heart failure, arrhythmias and cardiogenic shock,
early reperfusion after coronary occlusion in patient with ST-segment
myocardial infarction (STEMI) is associated with an improved
prognosis. Nowadays Primary PCI is the preferred reperfusion
strategy in patients with STEMI within 12 h of symptom onset.
Impaired angiographic reflow is still a challenging major issue in the
management of the patients with STEMI undergoing primary
percutaneous coronary intervention (PPCI) . Reduced coronary flow
after primary angioplasty (TIMI flow 0 to 2) is associated with worse
outcome than normal (TIMI 3) flow, even when no significant
epicardial obstruction remains and It is well known that impaired
coronary reflow is associated with large infarct size , worse functional
recovery , higher incidence of complication and short and long term
mortality in acute myocardial infarction.
According to many studies the predictors of No Reflow
phenomenon were (age, smoking, previous MI, Killip class, serum
creatinine, C-reactive protein, time-to-treatment interval, LVEF,
baseline TIMI flow grade, and initial perfusion defect). Microembolization
leads to platelet and inflammatory cell activation and to
vasospasm, which reduce coronary flow in combination with
mechanical plugging of the microcirculation. The platelet-lymphocyte
ratio (PLR) has recently been investigated as a new predicator for
major adverse cardiovascular outcome. It has been found that high
PLR is associated with poor coronary collateral development in stable
coronary artery disease and long term mortality. Sixty patients