【Abstract】Objective To explore the occurrence of no-reflow during percutaneous coronary intervention (PCI) in the elderly patients with acute coronary syndrome (ACS) and identify the associated factors. Methods A retrospective analysis was conducted on the clinical data of 510 elderly ACS patients who underwent PCI in Aoyang Hospital Affiliated to Jiangsu University from April 2020 to April 2023. Based on the occurrence of no-reflow during PCI, the patients were divided into the no-reflow group (n=110) and the non-no-reflow group (n=400). Differences in baseline characteristics and laboratory indicators between the two groups were compared. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of preoperative stenosis, intercellular adhesion molecule-1 (ICAM-1), and endothelial cell-specific molecule-1 (ESM-1) for the occurrence of no-reflow during PCI in the elderly ACS patients, and multivariable logistic regression analysis was conducted to identify the associated risk factors. SPSS statistics 20.0 was used for statistical analysis. Data comparison between two groups was performed using t test orχ2 test depending on the data type. Results The proportion of preoperative thrombolysis in myocardial infarction (TIMI) grade ≤2, balloon dilation ≥3 times, high thrombus burden, and non-usage of GPB/A receptor antagonists was significantly higher in the no-reflow group than in the non-no-reflow group. Preoperative stenosis degree, ICAM-1, and ESM-1 levels were significantly higher in the no-reflow group than in the non-no-reflow group, with statistical significance (P<0.05). ROC curve analysis of preoperative stenosis degree, ICAM-1, and ESM-1 showed good predictive value for the occurrence of no-reflow during PCI in the elderly ACS patients, and the combined predictive value was even higher, with a respective area under the curve of 0.869,0.952,0.866, and 0.980 (P<0.05 for all). Multivariable logistic regression analysis confirmed that preoperative TIMI grade ≤2, balloon dilation ≥3 times, high thrombus burden, non-usage of GPB/A receptor antagonists, pre-stenosis degree ≥89.345%, ICAM-1 ≥3.705 ng/ml, and ESM-1 ≥5.890 ng/ml were risk factors of the occurrence of no-reflow during PCI in the elderly ACS patients. Conclusion The occurrence of no-reflow in the elderly patients with acute coronary syndrome during elective PCI was influenced by various factors, and ROC analysis confirmed that preoperative stenosis ≥ 89.345%, ICAM-1≥3.705 ng/ml, and ESM-1≥5.890 ng/ml could be used to predict the occurrence of no-reflow.
