Accuracy of Low Haemoglobin Level in Predicting No-Reflow Phenomenon in Primary Percutaneous Coronary Intervention Patients
DOI:
https://doi.org/10.51253/pafmj.v76iSUPPL-8.14210Keywords:
Haemoglobin, No-Reflow, Thrombolysis in Myocardial InfarctionAbstract
Objective: To determine the accuracy of low haemoglobin level in predicting the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention.
Study Design: Cross-sectional analytical study
Place and Duration of Study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, Pakistan from Dec 2024 to May 2025.
Methodology: A total of 115 patients aged 30-70 years, regardless of gender, with acute STEMI undergoing PPCI were enrolled through consecutive sampling. Post-coronary artery bypass graft (CABG) patients, those who had received glycoprotein IIb/IIIa inhibitors before the procedure, patients presenting beyond 24 hours of symptom onset, with chronic kidney disease, and with a history of major bleeding or haemorrhagic disorders were excluded. Low haemoglobin was defined as <11.5 g/dL. The no-reflow phenomenon was described as TIMI flow grade <3.
Results: Among 115 patients [105(91.3%) male; median age 57.00(51.00–62.00) years], no-reflow was observed in 30(26.1%) patients. Patients with low haemoglobin (<11.5 g/dL) experienced higher no-reflow than with normal haemoglobin (p=0.018). The sensitivity and specificity were 16.7% and 97.6%, respectively, with a positive predictive value (PPV) of 71.4%, a negative predictive value (NPV) of 76.8%, and an overall diagnostic accuracy of 76.5%.
Conclusion: Low haemoglobin level demonstrated high specificity but poor sensitivity in predicting the no-reflow phenomenon following PPCI.
Downloads
References
Yaylak B, Altıntaş B, Özcan KS, Akdeniz E, Avcı İ, Zeren G, et al. Relation of hemoglobin level to no-reflow in patients with ST-segment elevation myocardial infarction undergoing primary coronary intervention. Adv Interv Cardiol W Kardiologii Interwencyjnej 2018; 14(4): 383–390.
https://doi.org/10.5114/aic.2018.79868
2. Wang L, Huang S, Zhou Q, Dou L, Lin D. The predictive value of laboratory parameters for no-reflow phenomenon in patients with ST-elevation myocardial infarction following primary percutaneous coronary intervention: A meta-analysis. Clin Cardiol 2024; 47(2): e24238.
https://doi.org/10.1002/clc.24238
3. Harrison RW, Aggarwal A, Ou F Shu, Klein LW, Rumsfeld JS, Roe MT, et al. Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction. Am J Cardiol 2013; 111(2): 178–184.
https://doi.org/10.1016/j.amjcard.2012.09.015
4. Rao S, Bhardwaj R, Negi PC, Nath RK. No reflow phenomenon in CAD patients after percutaneous coronary intervention: A prospective hospital based observational study. Indian Heart J 2023 Mar 1; 75(2): 156-159.
5. Apostolos A. Thrombogenicity and the No-Reflow Phenomenon in STEMI. J Am Coll Cardiol Asia 2025; 5(11): 1502–1504.
https://doi.org/10.1016/j.jacasi.2025.08.013
6. Khalfallah M, Allaithy A, Maria DA. Impact of the total ischemia time on no-reflow phenomenon in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Anatol J Cardiol 2022; 26(5): 382.
https://doi.org/10.5152/AnatolJCardiol.2021.846
7. Wang Z, Ren L, Liu N, Peng J. Utility of Hematological Parameters in Predicting No-Reflow Phenomenon After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb 2018; 24(7): 1177–1183.
https://doi.org/10.1177/1076029618761005
8. Akbar KMA, Dharma S, Andriantoro H, Sukmawan R, Mangkuanom AS, Rejeki VG. Relationship between Hemoglobin Concentration at Admission with the Incidence of No-Reflow Phenomenon and In-Hospital Mortality in Acute Myocardial Infarction with Elevation of ST Segments in Patients who underwent Primary Percutaneous Coronary Intervention. Int J Angiol Off Publ Int Coll Angiol Inc 2022; 32(2): 106–112.
https://doi.org/10.1055/s-0042-1742308
9. Separham A, Seyedi SZ, Sarvestani AH. The relationship between hemoglobin level and No-reflow phenomenon in patients with myocardial infarction undergoing primary PCI. Multidiscip Cardiovasc Ann 2021 ; 12(1): 107077.
https://doi.org/10.5812/mca.107077
10. Liu H, Zhang F, Li Y, Liu L, Song X, Wang J, et al. The HALP score predicts no-reflow phenomenon and long-term prognosis in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Coron Artery Dis 2025; 36(4): 273–280. https://doi.org/10.1097/MCA.0000000000001446
11. Refaat H, Tantawy A, Gamal AS, Radwan H. Novel predictors and adverse long-term outcomes of No-reflow phenomenon in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Indian Heart J 2021; 73(1): 35–43. https://doi.org/10.1016/j.ihj.2020.12.008
12. Shakiba M, Salari A, Mirbolouk F, Sotudeh N, Nikfarjam S. Clinical, Laboratory, and Procedural Predictors of No-Reflow in Patients Undergoing Primary Percutaneous Coronary Intervention. J Tehran Univ Heart Cent 2020; 15(2): 50–56.
https://doi.org/10.18502/jthc.v15i2.4183
13. Kuzmiak-Glancy S, Covian R, Femnou AN, Glancy B, Jaimes R, Wengrowski AM, et al. Cardiac performance is limited by oxygen delivery to the mitochondria in the crystalloid-perfused working heart. Am J Physiol-Heart Circ Physiol 2018; 314(4): H704–715. https://doi.org/10.1152/ajpheart.00321.2017
14. Kuzmiak‐Glancy S, Jaimes R, Wengrowski AM, Kay MW. Oxygen demand of perfused heart preparations: how electromechanical function and inadequate oxygenation affect physiology and optical measurements. Exp Physiol 2015; 100(6): 603–616.
https://doi.org/10.1113/EP085042
15. Khan IA, Shahzad SK. Association of Red Cell Distribution Width with Thrombus Burden in Patients of ST Elevation Myocardial Infarction Undergoing Primary PCI. Pak Armed Forces Med J 2023 73(Suppl-3): S457-462.
https://doi.org/10.51253/pafmj.v73iSUPPL-3.10497
16. Haq IU, Aslam U, Hamdani SHH, Yousuf S, Mahmood T, Yousuf MU. In-hospital Mortality in Patients with Low Haemoglobin Presenting with ST Elevated Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Indus J Biosci Res 2025; 3(3): 175–180.
https://doi.org/10.70749/ijbr.v3i3.762
17. Jonik S, Skrobucha A, Huczek Z, Kochman J, Opolski G, Grabowski M, et al. Impact of anemia on clinical outcomes in patients with multivessel coronary artery disease treated with percutaneous coronary intervention. Adv Interv Cardiol W Kardiologii Interwencyjnej 2024 ; 20(1): 144778 .
https://doi.org/10.5114/aic.2024.144778
18. Falah B, Redfors B, Zhao D, Bharadwaj AS, Basir MB, Thompson JB, et al. Implications of anemia in patients undergoing PCI with Impella-support: insights from the PROTECT III study. Front Cardiovasc Med 2024; 11: 1429900.
https://doi.org/10.3389/fcvm.2024.1429900
19. Shah SK, Danish N, Akhtar S, Khalil MSUD, Ali N, Amin QNU. Association of Hemoglobin Level with In-Hospital Outcomes in Patients with STEMI Treated with Primary Percutaneous Coronary Intervention. Pak Heart J 2025; 58(2): 252–257.
Downloads
Published
License
Copyright (c) 2026 Maria Nazir, Azhar Ali Chaudry, Usman Iqbal, Qamar-Uz-Zaman Bhatti, Gulzar Ali, Sarwat Paiker
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
