Platelet-To-Lymphocyte Ratio as a Predictor of No-Reflow after Primary Percutaneous Coronary Intervention in Patients with ST Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis

Introduction: No-reflow increases the complications and mortality rate of primary percutaneous coronary intervention (PCI). Therefore, it is important to identify patients at a higher risk of developing no-reflow. This study aimed to systematically review the prognostic value of the platelet-to-lymphocyte ratio (PLR) to predict no-reflow. Materials and Methods: The databases, such as Pubmed, EMBASE, and Web of Knowledge were searched for the relevant studies. Two authors independently performed data extraction and quality assessment of the included studies. In this meta-analysis, sensitivity and specificity of PLR, as well as the pooled odds ratio were calculated to predict no-reflow and compared with the pooled means of PLR in no-reflow and reflow groups. Results: According to the results obtained from six out of eight studies in this systematic review, there was a significant association between PLR and no-reflow. Moreover, a pooled six-fold increase of no-reflow risk was observed in the high PLR group. Pooled sensitivity and specificity of PLR to predict no-reflow was 65% (CI95%: 61%-69%) and 77% (CI95%: 76%-79%), respectively. The mean pooled of PLR in the no-reflow group was significantly 65.2 (CI95%: 26.7-103.8) units higher than that in the reflow group. Conclusions: The PLR is a significant predictor of no-reflow in STEMI patients subjected to primary PCI which can be used alone or in combination with other markers to identify patients at higher risk of developing no-reflow.