Arq Bras CardiolabcArquivos Brasileiros de CardiologiaArq. Bras. Cardiol.0066-782X1678-4170Sociedade Brasileira de Cardiologia - SBCjTnVxCFWXyPnM6yBKk7XsxQS0066-782X20240008009010090110.36660/abc.20240317Carta ao EditorIntervenção Coronária Percutânea Induziu No-reflow em Enxertos de Veia Safena0000-0003-0934-0266KanalYücel1Cumhuriyet University Faculty of MedicineSivasTurquiaCumhuriyet University Faculty of Medicine – Cardiology, Sivas – Turquia Sivas Cumhuriyet University Faculty of Medicine, 58140 Campus/Sivas, - Turquia E-mail: yucel_kanal@hotmail.com2309202420241218e20240317080520240406202404062024This is an open-access article distributed under the terms of the Creative Commons Attribution LicensePalavras-chaveFenômeno de não RefluxoVeia SafenaIntervenção Coronária Percutânea
Caro Editor,
Li com interesse o estudo intitulado "O valor preditivo do índice prognóstico inflamatório para detecção de no-reflow em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST",1 publicado em sua revista. Gostaria de contribuir com o estudo fornecendo alguns insights.
O estudo avaliou a relação entre vários parâmetros inflamatórios e no-reflow em pacientes submetidos a intervenção coronária percutânea (ICP) para infarto do miocárdio com supradesnivelamento do segmento ST.1 O fenômeno de no-reflow observado durante a ICP manifesta-se como uma redução ou cessação abrupta do fluxo sanguíneo coronariano anterógrado, apesar da ausência de fatores precipitantes claros, como espasmo, dissecção, macrotrombo distal, trombose in situ ou estenose coronariana residual.2 Apesar de alcançar precisão técnica na ICP, ainda podem ocorrer casos de comprometimento do fluxo após a colocação do stent. Especialmente em pacientes com enxertos de veia safena (EVS) degenerados, há uma tendência aumentada para o desenvolvimento do fenômeno de no-reflow.3 Estudos indicaram incidências variadas de no-reflow durante ICP, variando entre 12% e 25%, com exame específico de EVS em ICP revelando taxas entre 15% e 42%.4 Neste estudo, não há dados fornecidos quanto à inclusão de pacientes submetidos à ICP de EVS. Além disso, o estudo não contém informações sobre a relação entre ICP EVS e no-reflow. Portanto, contribuirei com alguns insights sobre o desenvolvimento do no-reflow seguindo ICP EVS.
Em nosso estudo que investigou a relação entre a relação proteína C reativa/albumina (CAR) e o no-reflow em pacientes submetidos à ICP EVS, observamos taxas significativamente mais altas de no-reflow em pacientes com níveis elevados de CAR. Nossa taxa geral de no-reflow foi determinada como 19,8%, enquanto no subgrupo com síndrome coronariana aguda (SCA) foi de 25,6%.4 Essas taxas são inferiores às relatadas em estudos anteriores pelos autores (11,5%).1 Acredito que a provável razão para isso seja a ausência de pacientes submetidos à ICP-EVS no estudo. Em estudo que avaliou a relação entre o índice de imunoinflamação sistêmica (SII) e a taxa de no-reflow em pacientes com SCA submetidos à ICP-EVS, observou-se que pacientes com índices de SII mais elevados apresentaram taxas significativamente maiores de no-reflow.5 Em outro estudo que realizamos anteriormente, se observou que os pacientes com escores de trombo TIMI (Thrombolysis in Myocardial Infarction) mais altos no vaso antes da ICP de EVS tinham taxas significativamente mais altas de no-reflow entre os que apresentavam SCA.6
Concluindo, existe um alto risco de desenvolvimento de no-reflow na ICP EVS. Portanto, especificar a proporção de pacientes com ICP EVS entre os grupos em estudos que avaliam o no-reflow aumentará a força do estudo.
ReferênciasŞaylıkFÇınarTTanboğaİHThe Predictive Value of the Inflammatory Prognostic Index for Detecting No-Reflow in ST-Elevation Myocardial Infarction PatientsArq Bras Cardiol20241214e2023064410.36660/abc.202306441 Şaylık F, Çınar T, Tanboğa İH. The Predictive Value of the Inflammatory Prognostic Index for Detecting No-Reflow in ST-Elevation Myocardial Infarction Patients. Arq Bras Cardiol. 2024;121(4):e20230644. doi: 10.36660/abc.20230644.RezkallaSHKlonerRACoronary No-reflow PhenomenonCurr Treat Options Cardiovasc Med200571758010.1007/s11936-005-0008-02 Rezkalla SH, Kloner RA. Coronary No-reflow Phenomenon. Curr Treat Options Cardiovasc Med. 2005;7(1):75-80. doi: 10.1007/s11936-005-0008-0.AdlakhaSSheikhMWuJBurketMWPandyaUColyerWStent Fracture in the Coronary and Peripheral ArteriesJ Interv Cardiol201023441141910.1111/j.1540-8183.2010.00567.x3 Adlakha S, Sheikh M, Wu J, Burket MW, Pandya U, Colyer W, et al. Stent Fracture in the Coronary and Peripheral Arteries. J Interv Cardiol. 2010;23(4):411-9. doi: 10.1111/j.1540-8183.2010.00567.x.KanalYKanalHEŞYakutİÖzenYÖzbayMBBalciKGCRP Albumin Ratio May Predict No Reflow in Patients Undergoing Percutaneous Coronary Intervention for Saphenous Vein Graft StenosisAngiology2023741556110.1177/000331972210982774 Kanal Y, Kanal HEŞ, Yakut İ, Özen Y, Özbay MB, Balci KG, et al. CRP Albumin Ratio May Predict No Reflow in Patients Undergoing Percutaneous Coronary Intervention for Saphenous Vein Graft Stenosis. Angiology. 2023;74(1):55-61. doi: 10.1177/00033197221098277.ÖzenYÖzbayMBAssessment of Systemic İmmune-inflammation İndex as an İndependent Surrogate Biomarker of No-reflow Phenomenon in Acute Coronary Syndrome Patients with Coronary Artery Bypass Grafting Undergoing Percutaneous Coronary İntervention of Saphenous Vein GraftEur Rev Med Pharmacol Sci20232762394240310.26355/eurrev_202303_317745 Özen Y, Özbay MB. Assessment of Systemic İmmune-inflammation İndex as an İndependent Surrogate Biomarker of No-reflow Phenomenon in Acute Coronary Syndrome Patients with Coronary Artery Bypass Grafting Undergoing Percutaneous Coronary İntervention of Saphenous Vein Graft. Eur Rev Med Pharmacol Sci. 2023;27(6):2394-403. doi: 10.26355/eurrev_202303_31774.MadenOKaraaslanÖÇKanalYYakutİYamanNMKönteHCAssociation of CHA2DS2-VASc Score with Thrombus Burden in Patients with Acute Myocardial İnfarction Undergoing SVG-PCIHerz202247545646410.1007/s00059-021-05070-x6 Maden O, Karaaslan ÖÇ, Kanal Y, Yakut İ, Yaman NM, Könte HC, et al. Association of CHA2DS2-VASc Score with Thrombus Burden in Patients with Acute Myocardial İnfarction Undergoing SVG-PCI. Herz. 2022;47(5):456-64. doi: 10.1007/s00059-021-05070-x.10.36660/abc.20240317iLetter to the EditorPercutaneous Coronary Intervention Induced-No-reflow in Saphenous Vein Grafts0000-0003-0934-0266KanalYücel1SivasTurkeyCumhuriyet University Faculty of Medicine – Cardiology, Sivas – Turkey Sivas Cumhuriyet University Faculty of Medicine, 58140 Campus/Sivas, - Turkey E-mail: yucel_kanal@hotmail.comKeywordsNo-Reflow PhenomenonSaphenous VeinPercutaneous Coronary Intervention
Dear Editor,
I have read with interest the study titled "The Predictive Value of the Inflammatory Prognostic Index for Detecting No-Reflow in ST-Elevation Myocardial Infarction Patients",1 published in your journal. I would like to contribute to the study by providing some insights.
The study evaluated the relationship between various inflammatory parameters and no-reflow in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction.1 The no-reflow phenomenon observed during PCI manifests as a reduction or abrupt cessation of antegrade coronary blood flow, despite the absence of clear precipitating factors such as spasm, dissection, distal macrothrombus, in situ thrombosis, or residual coronary stenosis.2 Despite achieving technical precision in PCI, instances of flow impairment may still ensue following stent placement. Especially in patients with degenerated saphenous vein grafts (SVG), there is an increased tendency for the development of the no-reflow phenomenon.3 Studies have indicated varying incidences of no-reflow during PCI, ranging between 12% and 25%, with specific examination of SVG in PCI revealing rates between 15% and 42%.4 In this study, there is no provided data regarding the inclusion of patients undergoing SVG PCI. Furthermore, the study does not contain information regarding the relationship between SVG PCI and no-reflow. Therefore, I will contribute some insights regarding the development of no-reflow following SVG PCI.
In our study investigating the relationship between the C-reactive protein to albumin ratio (CAR) and no-reflow in patients undergoing SVG PCI, we observed significantly higher rates of no-reflow in patients with elevated CAR levels. Our overall no-reflow rate was determined as 19.8%, while in the subgroup with acute coronary syndrome (ACS), it was 25.6%.4 These rates are lower than those reported in previous studies by the authors (11.5%).1 I believe the probable reason for this is the absence of patients undergoing SVG-PCI in the study. In a study evaluating the relationship between the systemic immune-inflammation index (SII) and the rate of no-reflow in patients with ACS undergoing SVG PCI, it was observed that patients with higher SII indices had significantly higher rates of no-reflow.5 In another study we conducted previously, it was observed that patients with higher Thrombolysis in Myocardial Infarction (TIMI) thrombus scores in the vessel before SVG PCI had significantly higher rates of no-reflow among those presenting with ACS.6
In conclusion, there is a high risk of developing no-reflow in SVG PCI. Therefore, specifying the proportion of SVG PCI patients among groups in studies evaluating no-reflow will enhance the strength of the study.