{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:58:47Z","timestamp":1790657927353,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2014neutrophil count, D-dimer, fibrinogen, high-sensitivity C-reactive protein, and platelet-neutrophil product\u2014by 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 &amp;lt; 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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];\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). In the fully adjusted model, NET-IP remained associated with angiographic no-reflow (OR per SD, 1.96; 95% CI, 1.46\u20132.62;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001) and tissue-level reperfusion failure (OR per SD, 1.64; 95% CI, 1.32\u20132.02;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). In the case-enriched ELISA subcohort, adjusted associations with no-reflow were observed for MPO-DNA (OR per SD log\n                      <jats:sub>2<\/jats:sub>\n                      , 1.88; 95% CI, 1.26\u20132.81;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.002) and H3Cit (OR per SD log\n                      <jats:sub>2<\/jats:sub>\n                      , 2.01; 95% CI, 1.33\u20133.02;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001), whereas double-stranded DNA was weaker after adjustment (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.074). NET-IP was also associated with higher peak high-sensitivity cardiac troponin I, higher peak creatine kinase-MB, lower discharge left ventricular ejection fraction (LVEF), large myocardial injury, and discharge LVEF &amp;lt; 50%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1926100","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:39:18Z","timestamp":1790656758000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhigang","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Aortic Surgery, Central China Subcenter of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhidong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Aortic Surgery, Central China Subcenter of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Aortic Surgery, Central China Subcenter of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangyuan","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Aortic Surgery, Central China Subcenter of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.03.054","article-title":"Myocardial no-reflow in humans","volume":"54","author":"Niccoli","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12175592","article-title":"Coronary no-reflow after primary percutaneous coronary intervention-current knowledge on pathophysiology, diagnosis, clinical impact and therapy","volume":"12","author":"Ndrepepa","year":"2023","journal-title":"J Clin Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.11.059","article-title":"Management of no-reflow phenomenon in the catheterization laboratory","volume":"10","author":"Rezkalla","year":"2017","journal-title":"JACC Cardiovasc Interv"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11082233","article-title":"No-reflow\" phenomenon: a contemporary review","volume":"11","author":"Annibali","year":"2022","journal-title":"J Clin Med"},{"key":"B5","doi-asserted-by":"crossref","DOI":"10.1161\/01.CIR.93.5.879","article-title":"TIMI frame count: a quantitative method of assessing coronary artery flow","volume":"93","author":"Gibson","year":"1996","journal-title":"Circulation"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.97.23.2302","article-title":"Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. 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