老年ST段抬高型急性心肌梗死患者急诊冠状动脉介入术后无复流的预测因素

Prognostic assesment of no-reflow after primary percutaneous coronary intervention in elderly patients with ST-elevation acute myocardial infarction

目的探讨老年ST段抬高型急性心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）后无复流的独立预测因素。方法人选668例STEMI并急诊成功行PCI的老年患者，分为无复流组和复流组，收集患者的临床、冠状动脉造影和PCI资料评价无复流，分析评价无复流的独立预测因素。结果668例老年患者中，发生无复流181例（27．1％）。多元Logistic回归分析结果显示，入院收缩压〈100mmHg（1mmHg=0．133kPa）、侧支血流0～1级、PCI前血栓负荷评分≥4分和使用主动脉内气囊反搏是老年STEMI患者急诊PCI后无复流的独立预测因素。随着无复流独立因素数量增加，无复流发生率显著升高，分别具有0、1、2、3和4个独立预测因素时无复流发生率分别是10．0％（2／20）、13．7％（32／233）、30．8％（85／276）、38．1％（37／97）和59．5％（25／42），差异有统计学意义（χ2=25．796，P〈0．01）。结论老年STEMI患者急诊PCI后无复流的独立预测因素为人院收缩压〈100mmHg、侧支血流分级O～1级、PCI前血栓评分≥4分和使用主动脉内气囊反搏。

Objective To identify independent predictors of no-reflow after primary percutaneous coronary intervention （PPCI） in aged patients with ST-elevation acute myocardial infarction （STEMI）, and thus construct a no-fellow predicting model. Methods Total of 668 aged patients with STEMI and successfully treated with PPCI were divided into the no-reflow group and the normal flow group. All clinical, angiographic and procedural data were collected. Multiple logistic regression analysis was used to identify independent no-reflow predictors. Results The no-reflow was found in 181 of 668 （27.1%） patients. Multiple stepwise logistic regression analysis identified that admission systolic blood pressure （SBP）〈100 mm Hg, collateral circulation 0-1 grade, pre-PCI thrombus score ≥ 4, and intra-aortic balloon pump （IABP） use before PCI were independent no- reflow predictors. The no-reflow incidence significantly enhanced as the numbers of independent predictors increased C10.0% （2/20）, 13.7% （32/233）, 30.8% （85/276）, 38. 1% （37/97）, and 59.5% （25/42） in patients with 0, 1, 2, 3, and 4 independent predictors, respectively,χ2=25. 796, P〈0.01） 3. Conclusions The no-reflow predictors are admission SBP %100 mm Hg, collateral circulation 0-1grade, pre-PCI thrombus score≥4, and IABP use before PCI in patients with STEMI and treated with PPCI. The prediction model may provide basis for therapeutic decision.