入院血糖对老年急诊冠脉介入后无复流的影响

Effect of admission hyperglycemia on no-reflow in elderly patients with ST-elevation acute myocardial infarction and primary percutaneous coronary intervention

目的 探讨入院血糖（APG）水平对老年急性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）后无复流的影响。方法入选712例STEMI成功行PPCI的老年患者，分为无复流组和复流正常组，收集患者的临床、冠状动脉造影和PCI资料评价无复流，采用多元logistic回归分析评价无复流的独立预测因素。结果在712例老年患者中，发生无复流148例（20．8％）。多元logistic回归分析结果显示，随着APG逐渐增加，无复流发生率也显著增加，APG为〈7．8mmol／L、7．8～11．0mmol／L、11．0～13．0mmol／L和〉13．0mmol／L时，无复流发生率分别为14．2％（26／183）、16．4％（48／292）、22．1％（19／86）和36．4％（55／151）（P=0．006）。结论入院血糖〉13．0mmol／L是老年STEMI患者PPCI后无复流的独立预测因素。

Objective To assess the association between admission plasma glucose （APG） and no-reflow after primary percutaneous coronary intervention （PPCI） in elderly patients with ST-elevation acute myocardial infarction （STEMI）. Methods 712 patients with STEMI successfully treated with PPCI were divided into no-retlow group and normal reflow group. Results The no-reflow was found in 148 （20.8%） of 712 patients, their APG level was significantly higher than the normal reflow group （12.6＋6.5 vs 8.7±4.4 mmol/L, P〈0.01）. Univariate and multivariate logistic regression identified that low SBP on admission 〈100 ram Hg, collateral circulation 0-1, pre-PCI thrombus score 34, and APG〉13.0 mmol/L were independent no-reflow predictors. The no-reflow incidence increased as APG increased [（14.2% （26/183）in patients with APG〈7.8 retool/L, 16.4% （48/292） in patients with APG 7.8 to 11.0 retool/L, 22.1% （19/86） in patients with APG 11.0 to 13.0 retool/L, 36.4% （55/151） in patients with APG〉13.0 mmol/L; P=0.006）]. Conclusion Admission plasma glucose〉13.0 mmol/L is an independent noreflow predictor in elderly patients with STEMI and PPCI.