A Newly Defined Inflammatory Predictor of the Postprocedural No-Reflow/Slow-Flow Phenomenon in Patients with Non-ST Segment Elevation Myocardial Infarction: Aggregate Index of Systemic Inflammation
Atilla Koyuncu
, Hasan Ali Sinoplu, Muhsin Kalyoncuoğlu, Alparslan Şahin, Mehmet Pişirici, Atakan Arpaç, Cennet Yıldız, Dilay Karabulut
Department of Cardiology, University of Health Sciences, Bakırköy Sadi Konuk Training and Research Hospital, Türkiye
Keywords: Aggregate index of systemic inflammation; inflammation; myocardial infarction; no-reflow.
Abstract
Objective: This study aimed to investigate the relationship between the Aggregate Index of Systemic Inflammation (AISI) and NRF/SF development in non-ST-elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI).
Methods: This retrospective observational study included 1092 NSTEMI patients who underwent PCI. Complete blood count-derived inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to- monocyte ratio (LMR), and AISI, were calculated before PCI. AISI was calculated using the ‘’neutrophil count x monocyte count x platelet/lymphocyte count’’ formula. NRF/ SF was defined as post- procedural TIMI flow <3 in the absence of mechanical obstruction. The study cohort was divided into 2 groups based on a median AISI score of 298. After determining the parameters associated with NRF/SF through univariate analysis, multivariate logistic regression analysis was performed to identify independent predictors. The De-Long test was conducted to assess the discriminatory ability and predictive performance of inflammation-based indices.
Results: A total of 94 (8.6%) patients suffered from NRF/SF, and it was more common in patients with high AISI values compared to those with low values (p< 0.001). Considering the inflammatory parameters, higher NLR (OR= 1.347, p<0.001), higher PLR (OR= 1.003, p=0.017), higher AISI (OR= 1.003, p<0.001) and lower LMR (OR= 0.713, p<0.001) independently predicted the NRF/SF development. De-Long test analysis revealed that AISI has better predictive performance compared to other inflammation-based scores (AUC= 0.703, p<0.001).
Conclusion: As an independent predictor of the NRF/SF phenomenon, AISI can serve as a practical and cost-effective biomarker for the early diagnosis of high-risk patients.
Cite This Article: Koyuncu A, Sinoplu HA, Kalyoncuoğlu M, Şahin A, Pişirici M, Arpaç A, et al. A Newly Defined Inflammatory Predictor of the Postprocedural No-Reflow/Slow-Flow Phenomenon in Patients with Non-ST Segment Elevation Myocardial Infarction: Aggregate Index of Systemic Inflammation. Koşuyolu Heart J 2026;29(1):68–75