急性心肌梗死患者急诊PCI术后无复流的危险因素分析

Predictors of the no-reflow phenomenon after primary percutaneous coronary intervention for acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者急诊PCI术后出现无复流的相关危险因素。方法发病在6h以内,或12 h内仍有持续胸痛的843名AMI患者给予急诊PCI,收集患者的临床、造影和介入治疗资料。PCI术后,根据TIMI血流分级和心肌显色分级两项结果将病人分为两组,正常血流组和无复流组。比较这两组病人基本临床资料、造影结果和手术相关资料的差异,分析AMI患者急诊PCI术后出现无复流的原因。结果急诊PCI术后无复流的发生率约为15.9%。通过单变量分析,既往MI病史、心梗Killip分级、症状至PCI时间、术前IABP应用、术前TIMl分级、病变长度、血栓负荷程度、再灌注方法与急诊PCI术后发生无复流有关(P<0.05)。多变量Logistic回归模型认为,症状至PCI时间(OR:1.60;95%CI:1.02～2.73)、术前TIMI血流分级(OR:1.1;95%CI:1.04～1.16)、病变血管长度(OR:1.40;95%CI:1.19～1.69),血栓负荷程度(OR:2.02;95%CI:1.47～2.76)可作为急诊PCI术后无复流发生的独立危险因素。结论症状至PCI时间、术前TIMI血流分级、病变血管长度和血栓负荷程度可作为AMI患者急诊PCI后发生无复流的独立预测因素。

Objective To identify the risk factors for no-reflow（NR） phenomenon after primary percutaneous coronary intervention（PCI） in patients with acute myocardial infarction.Methods A total of 843 patients with AMI underwent primary PCI within 12 h following onset of the ischemic symptoms.According to TIMI flow grade and myocardial blush grade,the patients were divided into reflow group and NR group after primary PCI,and the clinical data,angiography findings and surgical data were compared to analyze the factors contributing to NR.Results NR occurred in 15.9%of the AMI patients after primary PCI.Univariate analysis showed that previous myocardial infarction,Killip classes of MI,time to reperfusion,IABP use before PCI,TIMI flow grade before primary PCI,long target lesion,pre-PCI thrombus score and method of reperfusion were correlated to NR（P〈0.05 ）.Multiple logistic analysis identified the time to reperfusion（OR=1.60;95%CI：1.02-2.73）,TIMI flow grade before primary PCI（OR=1.1;95%CI：1.04-1.16）,long target lesion（OR=1.40;95%CI：1.19-1.69）,and pre-PCI thrombus score（OR=2.02;95%CI：1.47-2.76） as the independent predictors of NR after primary PCI.Conclusion The time to reperfusion,TIMI flow grade before primary PCI,long target lesion,and pre-PCI thrombus score are independent predictors of NR after primary PCI for AMI.