STEMI患者冠脉造影特征与PCI后无复流的关系及相关风险因素预测模型建立初探

The relationship between coronary angiographic features of patients with STEMI and no-reflow after PCI and the establishment of a predictive model for related risk factors

目的:探讨ST段抬高型心肌梗死(STEMI)患者冠脉造影特征与经皮冠脉介入手术(PCI)后无复流的关系及相关预测模型建立。方法:选取2017年1月~2020年6月本院采用PCI治疗后发生无复流的STEMI患者52例作为无复流组,以及未发生无复流患者104例作为对照组。收集患者的人口、临床及冠脉造影特征,采用Logistic回归模型筛选PCI后发生无复流的危险因素,建立预测模型,绘制受试者工作曲线(ROC)分析预测模型的临床应用价值。结果:起病至球囊扩张时间越长、术前Killip分级≥Ⅲ级、PCI前血栓负荷评分、术前TIMI血流≤1级、进行血栓抽吸是PCI术后发生无复流的独立危险因素。预测模型预测PCI术后发生无复流的AUC值为0.875,模型临界值为7.4分。结论:建立的预测模型可以用于预测STEMI患者PCI术后无复流的发生概率,从而识别高危患者,为制定临床决策提供参考依据。

Objective To explore the relationship between the clinical and coronary angiographic characteristics of patients with ST-segment elevation myocardial infarction(STEMI)and no reflow after percutaneous coronary intervention(PCI)and the establishment of related prediction models.Methods From January 2017 to June 2020,52 STEMI patients with no-reflow after PCI treatment in our hospital were selected as the no-reflow group,and 104 patients without no-reflow were selected as the control group.The demographic,clinical and coronary angiography characteristics of the patients were collected.The logistic regression model was used to screen the risk factors of no-reflow after PCI.The prediction model was established,and the receiver operating curve(ROC)was drawn to analyze the clinical application value of the prediction model.Results The longer the time from onset to balloon dilation,the preoperative Killip grade≥gradeⅢ,the pre-PCI thrombotic load score,the preoperative TIMI blood flow≤grade 1,and thrombus aspiration were independent risk factors for no reflow after PCI.The AUC value of predictive model predicted the no-reflow after PCI was 0.875,and the model critical value was 7.4 points.Conclusion The established prediction model can be used to predict the probability of no reflow in STEMI patients after PCI,so as to identify high-risk patients and provide a reference for making clinical decisions.