The Relationship Between Hemoglobin Level and No-Reflow Phenomenon in Patients with Myocardial Infarction Undergoing Primary PCI

Background: Anemia is a predictor of no reflow with high rate morbidity and mortality particularly in patients with heart failure. Objectives: The aim of this study was to investigate the relation between hemoglobin level and no-reflowing in patients with myocardial infarction undergoing primary PCI. Methods: In this retrospective cross sectional study, all patients with ST elevation myocardial infarction (STEMI) undergoing coronary angiography from 2016 till 2018 were included. According to post procedural TIMI flow, the patients were divided into two groups: patients with TIMI flow III and those with TIMI flow less than III. Patients’ demographic and laboratory data such as hemoglobin, hematocrit, platelets count, white blood cells, serum creatinine level and troponin were collected. To compare the quantitative variables chi square test and to compare qualitative variables t-test were applied by SPSS software version 19. Results: In this study 1200 patients with acute ST elevation myocardial infarction (STEMI) treated with primary PCI were included. The mean Hemoglobin level in normal TIMI group and low TIMI group were 14.15 ± 1.49 and 13.66 ± 1.69, respectively (P < 0.001). Our results also showed a significant lower RBC count (P < 0.001), lower HCT level (P < 0 .001) and lower RDW (P < 0.001) in those patients with lower TIMI flow. Based on the multivariate regression analysis lower hemoglobin has a significant association with lower TIMI flow and no-reflow (OR = 0.747, CI = 0.618 - 0.888, P < 0.001). Conclusions: Our study showed that in patients with STEMI undergoing primary PCI, hemoglobin level had a significant association with post procedural low TIMI flow and no-reflow. Our results emphasize the need for randomized control trials to evaluate the importance of pre-simultaneous blood transfusion in patients with anemia undergoing PPCI.