الفهرس 
ANATOMY & PHYSIOLOGY OF THE CORONARY VESSELS
Non-atherosclerotic Causes of Acute Myocardial Infarction:Only 14 pages are availabe for public view
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Abstract
To the best of our knowledge, this is the first study to assess and compare the significance of C- reactive protein albumin ratio versus coronary artery ectasia as predictors of the adverse no-reflow phenomenon in patients of ST-elevation myocardial infarction undergoing primary PCI. This prospective study was conducted on 90 patients admitted with acute STEMI at cardiovascular medicine department Tanta university hospitals. The pre-intervention CRP & albumin were examined in all patients, and they all underwent primary PCI within 24 hours of presentation. Data collection was done within 12 months started from June 2018. Patients were divided into two groups according to the post primary PCI thrombolysis in myocardial infarction (TIMI) flow score. group I (Case group), patients with no-reflow phenomenon TIMI 0-1 flow post primary PCI. group II (Control group) with TIMI flow ≥ 2 after primary PCI. Patients in group I were matched to group II regarding baseline demographic and clinical characteristics, risk factors, laboratory parameters on admission, angiographic and procedural characteristics, and short term complications. There was significant statistical difference between the no reflow and the control group as regard age )< 60 years, 96.7% vs 20%, P < 0.001), gender (male, 93.3% vs 63.3%, P = 0.002) , diabetes mellitus (83.3% vs 53.3%, p = 0.005), hypertension (86.7% vs 50%, p > 0.001), systolic blood pressure )> 90 mmHg, 66.7% vs 10%, p > 0.001), RBS )< 300 mg/dl, 83.3% vs 33.3%, p > 0.001), Killip class )< 2, 66.7% vs 10%, p > 0.001) , infarction localization (anterior, 73.3% vs 26.7%, p > 0.001), ischemia time ) < 6 hours, 100% vs 33.3%, p > 0.001), admission total leukocyte count (13.36 ± 1.14 x 109 cells/L vs 11.68 ± 1.28 x 109 cells/L, p > 0.001), serum creatinine (1.44± 0.26 mg/dL vs 1.16 ± 0.23 mg/dL, p > 0.001), CRP level (64 ± 32.6 mg/L vs 26.27 ± 21.5 mg/L, P value > 0.001), serum albumin (3.22 ± 0.23 g/dL vs 3.55 ± 0.20 g/dL, P value > 0.001), CRP albumin ratio (0.0204 ± 0.011 vs 0.0076 ± 0.0064, P value > 0.001), IRA (LAD, 76.7% vs 46.7%, P = 0.01), coronary artery ectasia (30% vs 6.7%, P value = 0.003), lesion localization (proximal, 73.3% vs 26.7%, P > 0.001), lesion length (< 20 mm, 100% vs 20%, P > 0.001), multi-vessel disease (40% vs 6.7%, P > 0.001), thrombus grade score ) ≥ 4, 100% vs 10%, P > 0.001), left ventricular ejection fraction (LVEF > 40%, 76.7% vs 30%, P > 0.001), cardiogenic shock (66.7% vs 13.3%, P > 0.001) and in-hospital mortality (70% vs 10%, P > 0.001). However, there was no significant statistical difference between both groups as regard smoking, dyslipidemia, family history of coronary artery diseases, heart rate, hemoglobin concentration, revascularization method, and experiencing malignant arrhythmia. TIMI flow 0-1 pre-PCI was found in all patients of no reflow group. However, there was no significant difference between the two groups (100% vs 91.7%, P = 0.162). Regarding coronary artery ectasia and compared to non-ectatic IRA patients, the ectatic IRA patients were males (100% vs 68.8%, P = 0.02), aged < 60 years (76.9% vs 40.3%, P = 0.01), hypertensive (100% vs 55.8%, P = 0.002) and smokers (84.6% vs 50.6%, P = 0.02). They showed higher frequency of inferior STEMI (76.9% vs 10.4%, P > 0.027) and a lower frequency of anterior and lateral STEMI (15.4%, 7.7% vs 46.8%, 35.1% respectively, P > 0.027). The IRA was predominantly the RCA (61.5% vs 11.7%, P > 0.027) and the lesion is predominantly mid-segment (69.2% vs 32.5%, P = 0.011). Longer lesion length (76.9% vs 41.6%, P = 0.02) and higher thrombus burden (100% vs 29.9%, P > 0.027) were significantly more often present in patients with CAE. Patients with CAE had a significantly higher prevalence of no-reflow (69.2% vs 27.3%, P = 0.003). The receiver operating characteristic (ROC) analysis showed the performance and predictive accuracy of CAR in predicting no reflow in our study, the area under the curve (AUC) was 0.843, confidence interval (CI) 0.752 – 0.933 (P < 0.001), with cutoff value CAR > 0.0103, with 80 % sensitivity and 80 % specificity. Accordingly, CAR was ≥ 0.0103 in 80% of the patients of the no reflow group and was < 0.0103 in 80% of the control group patients.