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Metabolic predictors of no-reflow in diabetic STEMI patients undergoing primary percutaneous coronary intervention Cover

Metabolic predictors of no-reflow in diabetic STEMI patients undergoing primary percutaneous coronary intervention

Open Access
|Nov 2025

Figures & Tables

Comparison between normal reflow and no reflow according to outcomes_

Normal reflow (n=83)With no reflow (n=37)P
Outcomes
Heart failure10 (12.0%)21 (56.8%)<0.001*
AF8 (9.6%)12 (32.4%)0.002*
Shock8 (9.6%)4 (10.8%)1.000
Cardiac arrest6 (7.2%)7 (18.9%)0.107
In hospital mortality3 (3.6%)3 (8.1%)0.371

Comparison between normal reflow and no reflow according to laboratory data, risk assessment, and outcomes_

Normal reflow (n=83)With no reflow (n=37)P
Hemoglobin (gm/dl)11.7 ± 0.511.6 ± 1.10.599
Platelets (x103/fl)231.02 ± 31.7268.03 ± 33.95>0.001*
WBCs (x103/fl)8.35 ± 0.738.21 ± 0.820.361
Cholesterol (mg/dl)201.2 ± 11.3204.4 ± 10.20.145
LDL (mg/dl)159.96 ± 11.62157.54 ± 9.30.227
HDL (mg/dl)45.4 ± 4.0237 ± 3.7>0.001*
TGs (mg/dl)147.9 ± 13.7212.2 ± 27.04>0.001*
RBG (mg/dl)136.6 ± 11.8134.14 ± 11.220.296
HbA1C (%)7.5 ± 0.37.5 ± 0.40.894
Serum creatinine (mg/dl)0.8 ± 0.11.22 ± 0.14>0.001*
Serum urea (mg/dl)17.33 ± 3.625.97 ± 4.11>0.001*
Uric Acid (mg/dl)8.7 ± 0.9913.51 ± 1.3>0.001*
Serum Na (Meq/L)137.7 ± 2.3138.1 ± 1.970.412
Serum K (Meq/L)4.53 ± 0.34.63 ± 0.340.106
GFR (ml/hr/1.73 m2)78.5 ± 6.4258.8 ± 5.53>0.001*

Univariate and multivariate logistic regression analysis of risk factors affecting no reflow_

UnivariateMultivariate
POR95% CIPOR95% CI
Age (years)<0.001*1.1821.081 – 1.2920.0531.4860.994 – 2.221
Sex (Female)0.8001.1140.484 – 2.561---
HTN0.026*2.5661.122 – 5.8730.058286480.7640.649 – 1.264
History of dyslipidemia0.033*2.5491.079 – 6.0210.0580.00.0 – 2.182
History of CAD0.7401.1440.518 – 2.527---
SBP (mmHg)<0.001*0.7730.701 – 0.8530.036*0.4610.224 – 0.950
DBP (mmHg)0.014*0.8900.812 – 0.9770.7120.9310.635 – 1.364
Hemoglobin (gm/dl)0.4970.8310.486 – 1.419---
Platelets (x103/fl)<0.001*1.0361.020 – 1.0520.047*1.1511.002 – 1.323
HDL (mg/dl)<0.001*0.6130.516 – 0.727---
TGs (mg/dl)<0.001*1.1441.078 – 1.214---
RBG (mg/dl)0.2940.9820.949 – 1.016---
HbA1C (%)0.8800.9020.237 – 3.433---
Serum Creatinine (mg/dl)0.9924.1582E810.0 – 0.0---
Serum Urea (mg/dl)<0.001*1.9221.498 – 2.467---
Uric Acid (mg/dl)0.032*126.0081.525- 10409.51---
Serum Na (Meq/L)0.4091.0790.901 – 1.293---
GFR (ml/hr/1.73 m2)<0.001*0.5540.409 – 0.749---
ECG (STEMI Type) ---
Anterior STEMI® 1.000 1.000
Lateral STEMI0.3860.6140.204 – 1.8491.0000.00.0 –
Inferior STEMI0.8631.1220.303 – 4.161.0000.00.0 –
Posterior STEMI0.9990.00.0 – 0.00.9990.00.0 –
Culprit Vessel
LAD® 1.000 1.000
RCA0.9790.9830.281 – 3.4420.9990.00.0
LCX0.3511.5800.604 – 4.1381.0000.0010.0
Affected vessel number (>2)0.2191.6320.747 – 3.5641.0000.7510.0

Comparison between the two study groups categorized by reflow status according to risk assessment, number of affected vessels, and culprit vessels_

Normal reflow (n=83)With no reflow (n=37)P
Initial TIMI flow grades pre-PCI
TIMI 065 (78.3%)30 (81.1%)0.002*
TIMI I3 (3.6%)7 (18.9%)
TIMI II12 (14.5%)0 (0.0%)
TIMI III3 (3.6%)0 (0.0%)
Thrombus grade
Nil (Grade 0)11 (13.3%)0 (0%)<0.001*
Low (Grade 1 – 2)41 (49.4%)3 (8.1%)
Moderate (Grade 3)22 (26.5%)7 (18.9%)
High (Grade 4 – 5)9 (10.8%)27 (73%)
Myocardial blush
> 282 (98.8%)1 (2.7%)<0.001*
≤ 21 (1.2%)36 (97.3%)
Culprit vessels
LAD59 (71.1%)24 (64.9%)0.632
RCA10 (12%)4 (10.8%)
LCX14 (16.9%)9 (24.3%)
Number of affected vessels
Single vessel46 (55.4%)16 (43.2%)0.021*
Two vessels29 (34.9%)10 (27%)
Multiple vessels8 (9.6%)11 (29.7%)

Comparison between normal reflow and no reflow according to demographic data, associated diseases/risk factors, blood pressure vessels and laboratory data_

Normal reflow (n=83)With no reflow (n=37)P
Age (years)50.1 ± 5.854.9 ± 5.2<0.001*
SexFemale58 (69.9)25 (67.6)0.800
Male25 (30.1)12 (32.4)
BMI (kg/m2)26.76 ± 0.8327.6 ± 0.85<0.001*
Diseases/risk factors
HTN19 (22.9%)16 (43.2%)0.024*
History of dyslipidemia16 (19.3%)14 (37.8%)0.030*
Smoking41 (49.4%)25 (67.6%)0.065
History of CAD31 (37.4%)15 (40.5%)0.740
Blood pressure
SBP (mmHg)121.3 ± 5.7111.43 ± 8.14<0.001*
DBP (mmHg)74.04 ± 3.871.5 ± 6.70.038*
Killip classification
176 (91.6%)3 (8.1%)<0.001*
24 (4.8%)5 (13.5%)
32 (2.4%)18 (48.7%)
41 (1.2%)11 (29.7%)

Comparison between the two study groups categorized by reflow status according to echocardiography_

Normal Reflow (n=83)With No Reflow (n=37)P
LVESD (mm)34.29 ± 1.3035.27 ± 1.50<0.001*
LVEDD (mm)55.57 ± 2.5247.65 ± 1.89<0.001*
LVEF (M-mode) (%)47.63 ± 3.3040.97 ± 3.58<0.001*
DOI: https://doi.org/10.2478/rjc-2025-0031 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X
Language: English
Page range: 258 - 266
Published on: Nov 20, 2025
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2025 Hatem Abdel Elrahman Helmy, Alzahraa Gamal Hasanien Sayed, Mahmoud Abdelsabour, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.