女性患者急诊冠状动脉介入后无复流的独立预测因素

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

目的在现代介入治疗时代评价女性急性ST段抬高型心肌梗死(ST-segment elevation acute myocardial infarction,STEMI)患者行急诊经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)后无复流的独立预测因素。方法入选320例STEMI并成功行PPCI的女性患者,分为无复流组和复流正常组。结果女性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,发现入院收缩压<100 mmHg(1 mmHg=0.133 kPa)(OR=1.991,95%CI:1.018～3.896;P=0.004)、靶病变长度>20 mm(OR=1.948,95%CI:1.908～1.990;P=0.016)、侧支循环0～1级(OR=1.952,95%CI:1.914～1.992;P=0.019)、PPCI前血栓负荷评分≥4(OR=4.184,95%CI:1.482～11.813;P=0.007)和PPCI前主动脉内气囊反搏(intra-aortic balloon pulsation,IABP)使用(OR=1.949,95%CI:1.168～3.253;P=0.011)是女性STEMI患者PPCI后无复流的独立预测因素。无复流发生率随预测因素增加而显著升高,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=0.000)。结论女性STEMI患者PPCI后无复流预测模型由5个因素组成:入院收缩压<100 mmHg、靶病变长度>20 mm、侧支循环0～1级、PPCI前血栓负荷评分≥4和PPCI前IABP使用。随着无复流预测因素增多,无复流发生率显著升高。

To identify independent no-reflow predictors during primary percutaneous coronary intervention （PPCI） in female patients with ST-segment elevation acute myocardial infarction（STEMI） after various contemporary interventional strategies, thus to establish a model for predicting no-reflow status. Methods Totally 320 female patients with STEMI successfully treated with PPCI were divided into no-reflow group and normal reflow group. Results The no-reflow status was found in 81 （25.3%） of 320 female patients. U nivariate and multivariate logistic regression identified that low systolic blood pressure （SBP） on admission（ 〈 100 mm Hg, OR = 1. 991, 95 % CI： 1.018 ~ 3. 896 ; P = 0. 004 ）, target lesion length （ 〉 20 mm, OR = 1. 948, 95 % CI： 1. 908 ~ 1. 990 ; P = 0.016 ）, collateral circulation（0-1, OR= 1. 952, 95% CI： 1. 914 - 1. 992; P=0. 019） , pre-PPCI thrombus score（ 〉14, OR=4. 184, 95% CI： 1. 482 11. 813 ; P=0. 007） , and intra-aortic balloon pulsation（IABP） use before PPCI （ OR = 1. 949, 95% CI： 1. 168 ~ 3. 253 ; P = 0. O11 ） 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= 0.000 ]. Conclusion The 5 no-reflow predictor variables were low SBP on admission 〈100 mm Hg, target lesion length 〉20 mm, collateral circulation 0-1, pre-PPCI thrombus score 〉t4, and IABP use before PPCI in female patients with STEMI and PPCI. The prediction model provides a basis for therapeutic decision making.