The relationship between serum rheumatoid factor level and no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Associations of Rheumatoid Factor, Rheumatoid Arthritis, and Interleukin-6 Inhibitor with the Prognosis of Ischemic Stroke: a Prospective Multicenter Cohort Study and Mendelian Randomization Analysis

Rheumatoid factor (RF), an established diagnostic biomarker for rheumatoid arthritis (RA), is associated with cardiovascular diseases, but its impact on clinical outcomes of ischemic stroke remains unclear. We aimed to investigate the observational associations between serum RF and prognosis of ischemic stroke, and further examined the genetic associations of RA and its therapeutic strategy, interleukin-6 (IL-6) inhibitor, with prognosis of ischemic stroke. We measured serum RF levels in 3474 Chinese ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke. The primary outcome was the composite outcome of death or major disability (modified Rankin Scale score ≥3) at 3 months after stroke onset. Mendelian randomization (MR) analyses were performed to examine the associations of genetically predicted RA and IL-6 inhibition with prognosis of ischemic stroke. During 3 months of follow-up, 866 patients (25.43%) experienced death or major disability. After multivariate adjustment, RF-positive was significantly associated with a high risk of primary outcome (OR, 1.47; 95% CI, 1.08-2.00; P =0.016) compared with RF-negative. The two-sample MR analyses suggested that genetically predicted RA was associated with an increased risk of primary outcome (OR, 1.09; 95% CI, 1.01-1.18; P=0.021), while genetically predicted IL-6 inhibition was associated with a decreased risk of primary outcome (OR, 0.88; 95% CI, 0.77-0.99; P=0.041). We found that positive RF was associated with increased risks of adverse outcomes after atherosclerotic ischemic stroke, and genetically predicted RA and IL-6 inhibition increased and decreased the risks of adverse outcomes after ischemic stroke, respectively.

No-Reflow Prediction in Acute Coronary Syndrome During Percutaneous Coronary Intervention: The NORPACS Risk Score

BACKGROUND

Suboptimal coronary reperfusion (no reflow) is common in acute coronary syndrome percutaneous coronary intervention (PCI) and is associated with poor outcomes. We aimed to develop and externally validate a clinical risk score for angiographic no reflow for use following angiography and before PCI.

METHODS

We developed and externally validated a logistic regression model for prediction of no reflow among adult patients undergoing PCI for acute coronary syndrome using data from the Melbourne Interventional Group PCI registry (2005-2020; development cohort) and the British Cardiovascular Interventional Society PCI registry (2006-2020; external validation cohort).

RESULTS

A total of 30 561 patients (mean age, 64.1 years; 24% women) were included in the Melbourne Interventional Group development cohort and 440 256 patients (mean age, 64.9 years; 27% women) in the British Cardiovascular Interventional Society external validation cohort. The primary outcome (no reflow) occurred in 4.1% (1249 patients) and 9.4% (41 222 patients) of the development and validation cohorts, respectively. From 33 candidate predictor variables, 6 final variables were selected by an adaptive least absolute shrinkage and selection operator regression model for inclusion (cardiogenic shock, ST-segment-elevation myocardial infarction with symptom onset >195 minutes pre-PCI, estimated stent length ≥20 mm, vessel diameter <2.5 mm, pre-PCI Thrombolysis in Myocardial Infarction flow <3, and lesion location). Model discrimination was very good (development C statistic, 0.808; validation C statistic, 0.741) with excellent calibration. Patients with a score of ≥8 points had a 22% and 27% risk of no reflow in the development and validation cohorts, respectively.

CONCLUSIONS

The no-reflow prediction in acute coronary syndrome risk score is a simple count-based scoring system based on 6 parameters available before PCI to predict the risk of no reflow. This score could be useful in guiding preventative treatment and future trials.

Stroke risk in rheumatoid arthritis patients: exploring connections and implications for patient care

Rheumatoid arthritis (RA) can independently increase the risk of stroke, affecting both young and adult RA patients. Recent attention has been drawn to the association between stroke and RA, supported by mounting evidence. Given that stroke is a significant and an urgent public health concern, this review aims to highlight the relationship between stroke and RA, covering mechanisms, underlying risk factors, early detection tools, and treatment implications. By uncovering the connection that links RA to stroke, we can pave the way for targeted healthcare practices and the development of preventive strategies for individuals with RA. Therefore, further research is imperative to deepen our understanding of this association and, ideally, guide treatment decisions for individuals at risk of both RA and stroke.

Impact of HAT2CH2 Score on the Development of No-Reflow Phenomenon in Patients With ST-Segment Elevation Myocardial Infarction

The HAT2CH2 score [Hypertension (1 point), Age > 75 years (1 point), Stroke/Transient ischemic attack (2 points), Chronic obstructive pulmonary disease (1 point), and Heart failure (2 points)] was originally developed to predict the occurrence of new-onset atrial fibrillation. The aim of the present study was to examine whether this score could predict the development of no-reflow phenomenon (NR) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Patients (n = 1552) with STEMI were consecutively enrolled in this single-center retrospective study. The SYNTAX score (SXscore) and HAT2CH2 score were calculated. The presence of thrombolysis in myocardial infarction (TIMI) score ≤2, without significant residual stenosis and mechanical obstruction, indicated the presence of NR. The HAT2CH2 score was significantly higher in the NR (+) group compared with the NR (-) group [2.29 ± 1.43 vs 1.46 ± 1.24, p < .001]. In multivariable logistic regression analysis, the HAT2CH2 score [OR = 1.585, p < .001] and SXscore [OR = 1.028, p = .017] were found to be independent predictors of NR. Receiver operating characteristic curve analysis showed that the HAT2CH2 score with a cutoff value of >2 determined NR, with 50.2% sensitivity and 79.4% specificity (AUC = .669, p < .001). In conclusion, the HAT2CH2 score may facilitate risk stratification in estimating NR in STEMI patients undergoing pPCI.

The ATRIA and Modified-ATRIA Scores in Evaluating the Risk of No-Reflow in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention

The no-reflow (NR) phenomenon is frequently encountered in acute coronary syndrome. We evaluated the association between anticoagulation and risk factors in atrial fibrillation (ATRIA) and modified ATRIA risk scores and NR in ST-elevation myocardial infarction (STEMI). Consecutive patients (n = 551) who underwent primary percutaneous coronary intervention between December 2019 and June 2020 due to STEMI were included. The mean age of the patients was 60.5 ± 10.8 years (n = 369, 67% male). The ATRIA and modified anticoagulation and risk factors in atrial fibrillation-hyperlipidemia, smoking, male (m-ATRIA-HS) scores were calculated. The NR group had higher frequency of diabetes mellitus (DM), serum creatine kinase-MB (CK-MB) levels, and corrected thrombolysis in myocardial infarction frame count (cTFC) (P = .002, P = .006, and P < .001, respectively). In regression analysis, ATRIA, m-ATRIA-HS, thrombus grade, and cTFC were independent predictors of NR. Age, higher CK-MB, and neutrophil-to-lymphocyte ratio and DM were the other predictors for NR. Pairwise comparison of receiver operating characteristics curve analysis showed that the m-ATRIA-HS (>2, area under curve [AUC]: 0.715) has better performance than ATRIA score (>1, AUC: 0.656), with a P < .022 and z statistics 2.279. In conclusion, ATRIA, especially the m-ATRIA-HS, can be used to evaluate NR risk in STEMI.

The relationship between serum rheumatoid factor level and no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVE

This study aimed to evaluate the relationship between serum rheumatoid factor (RF) levels and no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

METHODS

This single-center, cross-sectional study included a total of 318 consecutive patients who were diagnosed with STEMI and underwent primary PCI within 12 hours of the onset of symptoms. Baseline serum RF levels of all patients were measured. The diagnosis of no-reflow phenomenon was defined as a flow of TIMI II or less without the presence of dissection, mechanical obstruction, significant residual stenosis, or other plausible causes. The patients were divided into reflow group (n = 283) and no-reflow group (n = 46) regarding the angiographic features of thrombolysis in myocardial infarction (TIMI) flow of the infarct-related artery.

RESULTS

No-reflow phenomenon was observed in 13.8% of the patients. Median RF level was significantly higher in no-reflow group than in reflow group (18.5 (7.0-27.6) vs 8.0 (4.6-50.8), P < .001). Forward conditional logistic regression analysis demonstrated that body mass index (OR = 0.845, 95% CI: 0.765 to 0.933, P = .001), diabetes mellitus (OR = 5.257, 95% CI: 1.124 to 24.587, P = .035), baseline RF level (OR = 1.198, 95% CI: 1.108 to 1.295, P < .001), and SYNTAX score I (OR = 1.065, 95% CI: 1.025 to 1.107, P = .001) were the independent predictors of no-reflow phenomenon.

CONCLUSION

Baseline serum RF concentrations are independently associated with the no-reflow phenomenon in patients undergoing primary PCI for acute STEMI.