Ahmad Faraz, Usman Ahmad, Afreen Aneela, Aqeel Iffat, Farooq Tayyab, Nadeem Atif, Hanan Rana, Raza Ali
Cardiology, Shalamar Hospital, Lahore, PAK.
Cardiology, Integrated Medical Care Hospital, Lahore, PAK.
Cureus. 2025 Jun 22;17(6):e86521. doi: 10.7759/cureus.86521. eCollection 2025 Jun.
Background The no-reflow phenomenon is a serious complication that can occur after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI), leading to poor myocardial reperfusion and adverse outcomes. Objective This study aims to evaluate the association between admission plasma osmolarity and the occurrence of the no-reflow phenomenon in patients with STEMI undergoing primary PCI. Methods This retrospective cohort study was conducted at Shalamar Hospital, Lahore, Pakistan from February 2022 to February 2025. The study included 486 consecutive patients diagnosed with STEMI who underwent primary PCI. Patients aged ≥ 18 years, confirmed diagnosis of STEMI based on chest pain duration of more than 30 minutes, ST-segment elevation of ≥1 mm in at least two contiguous ECG leads, and elevated cardiac biomarkers were included in the study. Results In this study of 486 STEMI patients undergoing primary PCI, high plasma osmolarity (>295 mOsm/L) was significantly associated with an increased incidence of no-reflow (31.1%) compared to normal (13.4%) and low osmolarity groups (9.2%). The incidence of no-reflow was significantly higher in the high osmolarity group (31.1%) compared to the normal (13.4%) and low (9.2%) groups (p < 0.001). High plasma osmolarity was independently associated with an increased risk of no-reflow (adjusted odds ratio 2.94; 95% CI: 1.61-5.38; p < 0.001). Conclusion It is concluded that elevated plasma osmolarity is an independent predictor of the no-reflow phenomenon in STEMI patients undergoing primary PCI. Routine assessment of plasma osmolarity may offer a simple and effective method for early risk stratification, with potential implications for personalized management strategies to improve reperfusion outcomes.
无复流现象是ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗（PCI）后可能发生的一种严重并发症，会导致心肌再灌注不良及不良后果。目的：本研究旨在评估STEMI患者接受直接PCI时入院血浆渗透压与无复流现象发生之间的关联。方法：本回顾性队列研究于2022年2月至2025年2月在巴基斯坦拉合尔的沙勒马医院进行。研究纳入了486例连续诊断为STEMI并接受直接PCI的患者。年龄≥18岁、基于胸痛持续超过30分钟、至少两个相邻心电图导联ST段抬高≥1 mm以及心脏生物标志物升高确诊为STEMI的患者被纳入研究。结果：在这项对486例接受直接PCI的STEMI患者的研究中，与正常渗透压组（13.4%）和低渗透压组（9.2%）相比，高血浆渗透压（>295 mOsm/L）与无复流发生率增加显著相关（31.1%）。高渗透压组的无复流发生率（31.1%）显著高于正常组（13.4%）和低渗透压组（9.2%）（p<0.001）。高血浆渗透压与无复流风险增加独立相关（调整后的优势比为2.94；95%可信区间：1.61 - 5.38；p<0.001）。结论：得出结论，血浆渗透压升高是接受直接PCI的STEMI患者无复流现象的独立预测因素。血浆渗透压的常规评估可能为早期风险分层提供一种简单有效的方法，对改善再灌注结果的个性化管理策略具有潜在意义。
