预测急性心肌梗死急诊介入治疗无复流的临床和冠状动脉造影特征

Clinical and angiographic features for predicting no-reflow phenomenon in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

目的探讨急性心肌梗死急诊经皮冠状动脉介入治疗(PCI)后无复流的相关临床、冠状动脉造影特征。方法连续入选328例行急诊PCI的急性ST段抬高型心肌梗死,根据术后梗死相关动脉前向心肌梗死溶栓试验(TIMI)血流分为无复流组(TIMI血流≤2级,39例)和正常血流组(TIMI血流3级,289例),收集各项临床、冠状动脉造影及手术特征,应用统计学软件对各危险因素进行筛选。结果 328例患者的无复流发生率为11.9%。与正常血流组相比,无复流组表现为高龄、糖尿病比例高、入院时血糖水平高、胸痛至球囊扩张时间长(P值均<0.05),冠状动脉造影特征表现为长病变和PCI术前TIMI血流0/1级发生率较高(P值均<0.05)。多因素Logistic逐步回归分析显示,老年、PCI术前TIMI血流0/1级和长病变(>11.67mm)、入院时血糖水平>9.95mmol/L、延迟再灌注(胸痛至球囊扩张时间>6h)是发生无复流的独立危险因素(P值均<0.05)。结论一些临床特征(高龄、糖尿病比例高、入院血糖水平高、胸痛至球囊扩张时间长)和冠状动脉造影特点(长病变和PCI前TIMI血流0/1级)有助于预测急诊PCI后无复流的发生,术前应给予这类患者更为积极的预防措施。

Objective To investigate the clinical and angiographic features for predicting the no-reflow phenomenon in patients with acute myocardial infarction （AMI）undergoing primary percutaneous coronary intervention （PCI）. Methods A total of 328 consecutive patients with acute ST-segment elevation myocardial infarction （STEMI）, who underwent primary PCI, were included in the present study. The patients were divided into no-reflow group （TIMI≤2 grade, n = 39） and reflow group （TIMI 3 grade, n = 289） based on the TIMI blood flow after operation. The clinical, angiographic and procedural data were collected and subjected to logistic regression analysis to identify the independent risk factors. Results Thirty-nine （11. 9%） of the patients developed no-reflow phenomenon. Compared with reflow group, patients of the no-reflow group were older （P = 0.014）; and more patients in the no-reflow group had diabetes （P = 0. 044） and higher blood glucose level on admission （P〈0. 001 ）. Longer pain to balloon interval （P〈 0. 001 ） was also noticed in no-reflow group. Angiographic data revealed that no-reflow was more frequent in patients who had a longer target lesion （ P 〈0.001） and lower initial TIMI flow （P = 0.013）. Logistic regression analysis showed that age〉60, TIMI flow≤ 1 prior to POh blood glucose level on admission （〉9.95 mmol/L）, delayed reperfusion （〉6 h） ,and long lesion （〉 11.67 mm） were independent factors for no-reflow in primary PCI. Conclusion Clinical and angiographic features （old age, high incidence of diabetes, high blood glucose on admission, chest pain, longer target lesion, and TIMI 0/1 before POD can help to predict no-reflow phenomenon after primary PCI; more attention should be paid to patients with the above features before operation.