急性ST段抬高心肌梗死患者急诊经皮冠状动脉介入治疗无复流现象相关因素分析

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

目的探讨急性ST段抬高心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）中出现无复流的相关危险因素。方法选取发病在12h内的1059例STEMI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，根据心肌梗死溶栓（TIMI）分级和校正TIMI帧数将患者分为正常血流组和无复流组。比较两组患者的基本临床资料、造影结果和手术相关资料的差异，分析STEMI患者急诊PCI术中出现无复流的原因。结果急诊PCI术中无复流组患者118例。正常血流组941例，无复流发生率为11．14％。研究共纳入63个指标，通过单变量分析发现，年龄、症状至PCI时间、谷草转氨酶、氯吡格雷使用情况、干预病变数、狭窄程度及血栓负荷与急诊PCI术中发生无复流具有相关性（P〈0．05）。多变量Logistic回归模型认为，年龄（OR=1．04，95％CI：1．02—1．06）与血栓负荷（OR=1．72，95％CI：1．07～2．76）可作为预测急诊PCI术中无复流发生的独立危险因素。结论年龄与血栓负荷可作为预测急性STEMI患者急诊PCI术中发生无复流的独立危险因素，而糖尿病、高血压、高血脂、吸烟等冠心病的传统危险因素与无复流未见相关性。

Objective To identify the risk factors for no-reflow （NR） phenomenon during primary pereutaneous coronary intervention （PCI） in patients presenting with acute ST-segment elevation myocardial infarction （STEMI）. Methods A total of 1059 patients presenting with STEMI underwent primary PCI within 12 hours following onset of the ischemic symptoms. The patients were divided into the reflow and the NR group after primary PCI according to thrombolysis in myocardial infarction （TIMI） flow grade and corrected TIMI frame count （CTFC）. The clinical data, angiography findings and surgical data were compared to analyze the factors contributing to NR. Results NR occurred in 11.14% of the STEMI patients during primary PCI. Univariate analysis showed that age, time to PCI, glutamic-oxalacetic transaminase, clopidogrel use or not, number of lesions treated, stenosis degree, high-burden thrombus formation were correlated to NR （ P 〈 0. 05 ） among the 63 involved factors. Multiple logistic analysis identified the age （ OR： 1.04;95% CI： 1.02 - 1.06）, high-burden thrombus formation （ OR： 1.72;95% CI： 1.07 - 2. 76） as the independent predictors of NR during primary PCI. Conclusions Age, high-burden thrombus formation are independent predictors of NR during primary PCI for STEMI.