Predictive Value of the Endothelial Activation and Stress Index for No-Reflow in NSTEMI Patients Undergoing Percutaneous Coronary Intervention

Muhammet Cihat Çelik, Macit Kalçık, Abdullah Sarıhan, Orhan Karayiğit, Mücahit Yetim, Lütfü Bekar, Yağmur Ceren Doğru Yılmaz, Yusuf Karavelioğlu

Abstract

Background: The no-reflow phenomenon, defined as inadequate myocardial perfusion despite successful epicardial recanalisation, remains a major complication after PCI in NSTEMI. Endothelial dysfunction and microvascular injury are key mechanisms. The Endothelial Activation and Stress Index (EASIX), calculated as (LDH × creatinine) / platelet count, reflects systemic endothelial stress and may predict no-reflow.
Methods: This retrospective, single-centre study included 543 NSTEMI patients who underwent urgent or early PCI between 2022 and 2024. Patients were divided into no-reflow (TIMI ≤ 2) and normal flow (TIMI 3) groups. Logistic regression identified independent predictors; ROC analysis assessed predictive accuracy.
Results: No-reflow occurred in 72 patients (13.3%). These patients had higher EASIX, glucose, creatinine, LDH, and hs-CRP levels, and lower LVEF. Multivariate analysis showed that elevated EASIX (OR 2.155, 95% CI 1.211–3.835, p = 0.009), reduced LVEF (OR 0.900, 95% CI 0.868–0.933, p < 0.001), and LAD involvement (OR 1.854, 95% CI 1.113–4.717, p = 0.013) independently predicted no-reflow.
Conclusion: Elevated EASIX, reduced LVEF, and LAD culprit lesion independently predict no-reflow in NSTEMI patients after PCI. EASIX, derived from routine tests, offers a simple and cost-effective tool for early identification of patients at high risk of microvascular obstruction.