, Volume 40, Issue 3, pp 502–506 | Cite as

Link between aortic valve sclerosis and myocardial no-reflow in ST-segment elevation myocardial infarction

  • L. Korkmaz
  • H. Erkan
  • M.T. Ağaç
  • E. Pelit
  • H. Bektas
  • Z. Acar
  • I. Gurbak
  • F. Kara
  • Ş. Çelik
e-Herz: Original article



The“no-reflow” phenomenon is associated with a worse prognosis at follow-up for patients with acute ST-segment elevation myocardial infarction (STEMI). Predicting and preventing no-reflow is therefore a crucial step in improving the prognosis of STEMI patients. The purpose of this study was to investigate the association between aortic valve sclerosis (AVS) and myocardial no-reflow in patients with STEMI.

Patients and methods

Patients with a first-time diagnosis of STEMI were enrolled consecutively. No-reflow was defined as a final TIMI 3 flow with a myocardial blush of grade < 2, temporary epicardial coronary no-reflow, and distal coronary occlusion. AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow.


No-reflow developed in 41 patients. In univariate analysis, age, male gender, smoking, culprit lesion Syntax score (SX score), and hypertension were significantly associated with no-reflow. Multivariate binary logistic regression analyses demonstrated age [95 % confidence interval (CI), 1.024–1.096; p=0.001), AVS (95 % CI, 1.002–1.100; p=0.039], culprit lesion SX score (95 % CI, 1.08–1.021 p=0.008), and symptom-to-balloon time (95 % CI, 1.020–1.097; p=0.002) as independent determinants of myocardial no-reflow.


AVS was significantly and independently associated with myocardial no-reflow in STEMI patients.


Aortic valve sclerosis Myocardial infarction No-reflow phenomenon ST-segment elevation myocardial infarction Prognosis 

Zusammenhang zwischen Aortenklappensklerose und No-Reflow-Phänomen bei ST-Strecken-Hebungs-Infarkt



Das No-Reflow-Phänomen, also das Sistieren des Blutflusses in den Koronarien, geht bei Patienten mit akutem ST-Strecken-Hebungs-Infarkt (STEMI) mit einer schlechteren Prognose im Verlauf einher. Die Vorhersage und Prävention des No-Reflow-Phänomens stellt daher einen entscheidenden Schritt zur Verbesserung der Prognose von Patienten mit STEMI dar. Ziel der vorliegenden Studie war es, den Zusammenhang zwischen Aortenklappensklerose (AVS) und myokardialem No-Reflow-Phänomen bei Patienten mit STEMI zu untersuchen.


Patienten mit Erstdiagnose eines STEMI wurden nacheinander in die Studie aufgenommen. Das No-Reflow-Phänomen wurde definiert als letztlich erzielter Fluss des Grades 3 gemäß TIMI („thrombolysis in myocardial infarction“) mit myokardialem Anfärbungsgrad („blush grade“) < 2, temporäres epikardiales koronares No-Reflow-Phänomen und distaler Koronarverschluss. Zur echokardiographischen Definition einer AVS gehören die Verdickung und Verkalkung der normalen dreizipfligen Aortenklappe ohne Obstruktion des linksventrikulären Ausstroms.


Bei 41 Patienten fand sich ein No-Reflow-Phänomen. In der univariaten Analyse standen Alter, männliches Geschlecht, Rauchen, Syntax-Score der zugrunde liegenden Läsion (SX score) und Hypertonie in einem signifikanten Zusammenhang mit dem No-Reflow-Phänomen. Die multivariate binäre logistische Regressionsanalyse ergab Alter (95%-Konfidenzintervall, 95%-KI: 1,024–1,096; p: 0,001), AVS (95%-KI: 1,002–1,100; p: 0,039) und SX score (95%-KI: 1,08–1,021; p: 0,008) sowie Zeitdauer zwischen Symptom und Ballondilatation (95%-KI: 1,020–1,097; p: 0,002) als unabhängige Determinanten eines myokardialen No-Reflow-Phänomens.


Eine AVS stand in signifikanter und unabhängiger Weise mit einem myokardialen No-Reflow-Phänomen bei STEMI-Patienten in Zusammenhang.


Aortenklappensklerose Herzinfarkt Fehlende Perfusion ST-Strecken-Hebungs-Infarkt Prognose 


Compliance with ethical guidelines

Conflict of interest. L. Korkmaz, H. Erkan, M.T. Ağaç, M. Pelit, H. Bektas, Z. Acar, I. Gurbak, F. Kara, and Ş. Çelik state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.


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Copyright information

© Urban & Vogel 2014

Authors and Affiliations

  • L. Korkmaz
    • 1
  • H. Erkan
    • 1
  • M.T. Ağaç
    • 1
  • E. Pelit
    • 1
  • H. Bektas
    • 1
  • Z. Acar
    • 1
  • I. Gurbak
    • 1
  • F. Kara
    • 1
  • Ş. Çelik
    • 1
  1. 1.Department of CardiologyAhi Evren Cardiovascular and Thoracic Surgery Training and Research HospitalTrabzonTurkey

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