الفهرس 
The No-Reflow PhenomenonOnly 14 pages are availabe for public view
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Abstract
Background: The no-reflow phenomenon is defined as the occurrence of areas with extremely low tissue flow after reopening the target vessel. Current knowledge suggests that the no-reflow phenomenon is caused by the damage to microvascular integrity established both during ischemia and during reperfusion. Several factors, such as plasma ET-1 level, TIMI thrombus grade, and female gender, have shown predictive value for the no-reflow phenomenon. D-dimer is a final product of fibrin degradation by plasmin, the plasma concentrations of which increase in subjects with ongoing or recent thrombosis; its levels reflect the fibrin turnover and gives an indirect estimation of the size of the thrombotic mass available for fibrinolysis and the severity of hypercoagulable state. Moreover, high thrombus burden is known to be associated with no-reflow phenomenon.
Objective: To determine the value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction,
Patients and Methods: The study was conducted among 100 patients admitted in coronary care unit and coronary catheterization lab unit of cardiology department in Ain Shams University Hospital & Misr University Hospital. Patients were classified into four groups group I: patient with no-reflow with high level of plasma D-dimer. group II: patient with no-reflow with normal level of plasma D-dimer. group III: patient with TIMI III flow with high level of plasma D-dimer. group IV: patient with TIMI flow with normal level of plasma D-dimer.
Results: Most of them (86%) were males (n.= 86). Age of the patients ranged from 25 to 92 years with a mean ± SD of age was 53.33 ± 13.50. More than half of the patients (55%) were current or ex-smokers, with 47% and 8% for smokers and ex-smokers respectively. More than half of the patients had negative history for hypertension (55%), diabetes (61%) and dyslipidemia (61%). Most of the patients (94%) had negative family history, and most of them (90%) had negative history of stroke. Laboratory findings of the patients showed that, D-dimer level ranged from 210 to 776 ng/ml with mean± SD was 415.35 ± 164.91 ng/ml. More than have of the patients (55%) had D-dimer levels <500 ng/ml. mean± SD of LDL was 132.28 ± 53.80 ng/ml while mean± SD of Cholesterol was 209.87 ± 60.67 and TGs 205.55 ± 114.81 ng/ml. Coronary angiography showed that most of the patients (83%) had one affected artery. More than half of the patients (56%) had negative RCA, while more than half of the patients (56%) had positive LAD.
Conclusion: D-dimer level on admission independently predicts no-reflow after p-PCI. High D-dimer level on admission has an independent prognostic value. Further studies are recommended to investigate the prognostic value of D-dimer in predicting outcome of the myocardial infarction patients. And also to investigate whether high D-dimer levels on admission might be a selection criteria for more aggressive complementary treatment strategies to improve microvascular perfusion after p-PCI.