Vitamin D level predicts angiographic no-reflow phenomenon after percutaneous coronary intervention in patients with ST segment elevation myocardial infarction

Biomark Med. 2021 Oct;15(15):1357-1366. doi: 10.2217/bmm-2020-0689. Epub 2021 Sep 17.


Aim: No-reflow phenomenon (NRP) is an undesirable result of coronary interventions, and usually occurred during the primary percutaneous coronary intervention (PPCI). On the other hand, there is growing evidence of epidemiological studies suggest that serum 25 hydroxy-vitamin D (25(OH)D3) level is significantly associated with cardiovascular mortality and morbidity. Objective: To investigate whether there is a relationship between admission serum 25(OH)D3 levels and NRP in patients with ST elevation myocardial infarction (STEMI). Methods: This study consisted of 496 consecutive acute STEMI patients who underwent PPCI. After the restoration of antegrade flow, the patients were divided into the normal flow and no-reflow groups. No-reflow defined as; thrombosis in myocardial infarction (TIMI) flow grade ≤2, or a TIMI flow grade = 3 with a myocardial perfusion grade ≤1. Results: Angiographic no-reflow occurred 18.2% of all study patients. Serum 25(OH)D3 levels were significantly lower when compared with the normal flow group (14.6 ± 7.3 vs 22.6 ± 9.6 ng/ml; p < 0.001). 25(OH)D3 level was significantly negatively correlated with Neutrophil/lymphocyte (N/L) ratio. In multivariate analysis, 25(OH)D3 level on admission (OR: 0.738; 95% CI: 0.584-0.878; p = 0.001) was found an independent predictor of NRP together with N/L ratio, N-Terminal-proBNP, balloon pre dilatation and syntax score I. On receiver operating curve analysis (ROC), the cut-off value of admission 25(OH)D3 level was 10.5 ng/ml for the prediction of NRP with a sensitivity of 93% and specificity of 68%. The area under the ROC curve (AUC) was 0.772 (95% CI: 0.697-0.846; p < 0.001). Conclusion: We have shown that lower 25(OH)D3 level on admission is associated with higher NRP frequency and may be used as a predictor for NRP in STEMI patients undergoing PPCI.

Keywords: STEMI; neutrophil/lymphocyte ratio; no-reflow; reperfusion injury; vitamin D.

MeSH terms

  • Aged
  • Biomarkers / blood*
  • Coronary Angiography / methods*
  • Female
  • Humans
  • Leukocyte Count
  • Lymphocytes / pathology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neutrophils / pathology
  • No-Reflow Phenomenon / blood*
  • No-Reflow Phenomenon / diagnosis
  • Percutaneous Coronary Intervention / methods*
  • Predictive Value of Tests
  • Prognosis
  • ROC Curve
  • ST Elevation Myocardial Infarction / blood*
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / surgery
  • Vitamin D / blood*


  • Biomarkers
  • Vitamin D