ArticleFrontiers in immunology2026
A NET-associated immunothrombotic phenotype is associated with coronary no-reflow and myocardial injury after primary PCI in ST-segment elevation myocardial infarction: a real-world translational cohort.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Coronary no-reflow after primary percutaneous coronary intervention (PCI) reflects failure of myocardial reperfusion despite treatment of the culprit epicardial lesion. Neutrophil extracellular traps (NETs) and immunothrombosis provide a plausible link between sterile inflammation, thrombus biology, and microvascular obstruction. We evaluated whether a clinically measurable NET-associated immunothrombotic phenotype (NET-IP) was associated with no-reflow and myocardial injury after primary PCI. Methods: This single-center translational cohort included 742 patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. NET-IP was calculated in 725 patients from five admission or pre-PCI variables-neutrophil count, D-dimer, fibrinogen, high-sensitivity C-reactive protein, and platelet-neutrophil product-by averaging log-transformed component z scores when at least four components were available, followed by standardization of the composite score. The primary endpoint was angiographic no-reflow, defined as final thrombolysis in myocardial infarction flow grade < 3 in the absence of mechanical epicardial obstruction. A case-enriched nested enzyme-linked immunosorbent assay (ELISA) biomarker subcohort was used to measure MPO-DNA, citrullinated histone H3 (H3Cit), and double-stranded DNA. Results: Angiographic no-reflow occurred in 110 of 742 patients. NET-IP was calculable in 725 patients, and the fully adjusted complete-case models included 700 patients. Patients with no-reflow had higher admission NET-IP scores than those with normal reflow (0.73 [0.24, 1.25] vs. -0.06 [-0.77, 0.54]; Conclusion: A NET-IP was linked to impaired coronary reperfusion and myocardial injury after primary PCI in STEMI. The findings support NET-associated immunothrombosis as a clinically measurable immune phenotype but do not establish direct NET burden, causal mediation, or immediate clinical treatment guidance.
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