Serum B-type natriuretic peptide on admission can predict the 'no-reflow' phenomenon after primary drug-eluting stent implantation for ST-segment elevation myocardial infarction

Int J Cardiol. 2010 May 28;141(2):175-81. doi: 10.1016/j.ijcard.2008.11.189. Epub 2009 Jan 13.


Background: The angiographic 'no-reflow' phenomenon after primary percutaneous coronary intervention (PPCI) is associated with a poor short-term and long-term clinical prognosis of ST-elevation myocardial infarction (STEMI). Although the increasing use of primary drug-eluting stent (DES) deployment for STEMI resulted in reduced adverse clinical outcomes, the prevalence of no-reflow has been unchanged. The purpose of our study was to evaluate the predictors for no-reflow for STEMI and identify such high-risk patients in the DES era.

Methods: The study prospectively enrolled 300 consecutive STEMI patients (80% men; 57+/-11 years) who underwent PPCI within 12 h of symptom onset. The no-reflow phenomenon was defined as an angiographic outcome of Thrombolysis In Myocardial Infarction (TIMI) grade <3 without accompanying mechanical factors.

Results: Compared to normal reflow patients, no-reflow patients (n=15, 5% of the total study population) were older (64+/-13 vs. 57+/-11 years; P=0.019), transferred to hospital later (7.1+/-3.2 vs. 4.5+/-3.8 h; P=0.011), and had a higher TIMI risk score (5.5+/-2.0 vs. 3.8+/-2.2; P=0.004). B-type natriuretic peptide (BNP), high sensitivity C-reactive protein, and serum creatinine levels were higher in the no-reflow than the normal reflow group. Multivariate analysis (including clinical, angiographic and procedural variables with a P<0.2 in univariate analysis) showed that high BNP level on admission was the only independent predictor of no-reflow. The area under the receiver-operating characteristics curve analysis value for BNP was 0.786. BNP > or =90 pg/ml showed a sensitivity of 80% and a specificity of 70% for predicting no-reflow after primary DES implantation (OR 14.953, 95% CI 3.131-71.419, P=0.001).

Conclusions: Angiographic 'no-reflow' phenomenon after primary DES implantation for STEMI can be predicted by BNP levels on admission. BNP-guided approach may be useful in identifying patients at high risk of the no-reflow phenomenon after primary stenting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Angioplasty, Balloon, Coronary*
  • Biomarkers / blood
  • C-Reactive Protein / analysis
  • Coronary Angiography
  • Creatinine / blood
  • Drug-Eluting Stents*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / blood
  • Myocardial Infarction / therapy*
  • Natriuretic Peptide, Brain / blood*
  • No-Reflow Phenomenon / blood*
  • Patient Admission
  • Patient Transfer
  • Prospective Studies
  • ROC Curve
  • Risk Assessment


  • Biomarkers
  • Natriuretic Peptide, Brain
  • C-Reactive Protein
  • Creatinine