急性ST段抬高型心肌梗死急诊PCI慢血流或无复流的相关因素研究

Predictors of Coronary Slow Flow or No-reflow Phenomenon by Primary Percutaneous Coronary Intervention on Acute Myocardial Infarction

目的探讨急性心肌梗死(AMI)患者急诊PCI术中、术后发生慢血流或无复流(CSRF或NR)现象的相关危险因素。方法符合2012年中华医学会制定的《中国经皮冠状动脉介入治疗指南》中急诊PCI适应症的1048例AMI患者,根据术后冠脉TIMI血流分级将患者分为正常血流组与异常血流组,对两组患者的临床资料、造影结果及介入治疗方法进行比较分析。结果急诊PCI患者中异常血流发生率为18.2%。统计分析表明既往血运重建、killip心功能分级、缺血时间、主动脉球囊反搏(IABP)、病变血管、冠脉弥漫病变、血栓征象、术前血流TIMI分级、瘤样扩张、介入治疗方法及是否使用替罗非班与异常血流相关(P<0.05)。应用Logistic多元逐步回归模型分析表明缺血时间、血栓征象、术前TIMI分级、病变为弥漫病变、介入方式可作为CSFP或NR发生的预测因素,使用替罗非班可作为预防CSFP或NR发生的保护因素。结论急性心肌梗死患者缺血时间、血栓征象、术前TIMI分级、弥漫病变、介入方法可作为CSFP或NR发生的预测因素,使用替罗非班可作为预防CSFP或NR的保护因素。

Objective To discuss the risk factors of coronary slow flow or no-reflow Phenomenon during Primary percutaneous coronary intervention on acute myocardial infarction. Methods There were 1048 patients with AMI accepting PCI, Conforming to the emergency PCI indications of China percutaneous coronary interventional treatment guideline 2012 established by the Chinese Medical Association. According to TIMI flow grade after PCI, the patients were divided into normal flow group and abnormal flow group, which were compared in the clinical and angiographic features to determine the risk factors of CSFPNR. Results he incidence of CSFP NR was 18.2% in AMI patients accepting primary PCI. Statistical analysis indicated that revascularization, killip classification, ischemia time, IABP use before PCI, left circumflex artery and right coronary lesion, diffuse lesions, thrombotic sign, TIMI grade before PCI, coronary artery ectasia, interventional method and whether to use tirofiban are associated with CSFPNR（P 0.05）. Statistical analysis by Logistic multivariate stepwise regression model indentified that ischemia time, thrombosis signs, TIMI grade before PCI, diffuse lesions, intervene- tional method can be used as predictors of CSFP or NR, and treatment with tirofiban before PCI can be used as protection factors. Conclusion Ischemia time, thrombosis signs, TIMI grade before PCI, diffuse lesions, interventional method are the risk factors of CSFPNR and using tirofiban before PCI is the preventive factor in AMI patients.