老年女性患者急诊冠脉介入后无复流的独立预测因素

A prediction model for no-reflow in elderly female patients treated with primary percutaneous coronary intervention

目的探讨老年女性急性ST段抬高型心肌梗死（STEMI）患者行急诊经皮冠状动脉介入治疗（PPCI）后无复流的独立预测因素。方法人选320例STEMI并成功行PPCI的老年女性患者，分为无复流组和复流正常组，探讨PPCI后无复流的独立预测因素。结果老年女性STEMI患者行PPCI后无复流发生率为25．3％（81／320）。经单变量和多元logistic回归分析发现，收缩压（sBP）〈100mmHg、靶病变长度〉20mm、侧支循环0-1级、PCI前血栓负荷评分≥4和PCI前IABP使用是女性STEMI患者PPCI后无复流的独立预测因素。无复流发生率随无复流预测因素数量增加而显著升高，具有0、1、2、3、4和5个无复流独立预测因素时无复流发生率分别为0％（0／2）、10．8％（9／84）、14．5％（17／117）、37．7％（29／77）、56．7％（17／30）和81．8％（9／11）（P〈0．01）。结论老年女．陛STEMI患者PPCI后无复流预测模型由5个因素组成：入院SBP〈100mmHg、靶病变长度〉20mm、侧支循环0-1级、PCI前血栓负荷评分≥4和PCI前使用IABP。随着无复流独立预测因素增多，无复流发生率显著升高。

Objective To identify independent no-reflow predictors during primary percutaneous coronary intervention （PPCI） in elderly female patients with ST-segment elevation acute myocardial infarction （STEMI） after various contemporary interventional strategies, thus to construct a predicting no-reflow model. Methods 320 elderly female patients with STEMI successfully treated with PPCI were divided into no-reflow group and normal reflow group. Results The no-reflow was found in 81 （25.3%） of 320 elderly female patients. Univariate and multivariate logistic regression identified that low SBP on admission 〈100 mm Hg, target lesion length〉20 mm, collateral circulation 0-1, pre-PCI thrombus score ≥4, and IABP use before PCI were independent no-reflow predictors. The no-reflow incidence rate significantly increased as the numbers of independent predictors increased [0%（0/2）, 10.8%（9/84）, 14.5%（17/117）, 37.7%（29/77）, 56.7%（17/30）, and 81.8%（9/11）in female patients with 0, 1, 2, 3, 4, and 5 independent predictors, respectively, P〈0.01]. Conclusion The no-reflow predictor variables were low SBP on admission〈 100 mm Hg, target lesion length〉20 mm, collateral circulation 0- 1, pre-PCI thrombus score ≥ 4, and IABP use before PCI in elderly female patients with STEMI and PPCI. The prediction model provides a basis for therapeutic decision making.