β受体阻滞剂服用史与急性心肌梗死直接经皮冠状动脉介入治疗后无复流的相关性

The impact of pre-primary percutaneous coronary intervention β blocker use on the no-reflow phenomenon in patients with acute myocardial infarction

目的 探讨急性ST段抬高型心肌梗死患者既往服用β受体阻滞剂与直接经皮冠状动脉介入治疗（PCI）后发生无复流的相关性.方法 入选北京安贞医院和解放军总医院2007年1月至2011年6月入院的发病12 h内行PCI的急性ST段抬高型心肌梗死患者1 615例进行回顾性分析.将患者分为β受体阻滞剂组（入院前服用β受体阻滞剂≥1个月,共257例）和非β受体阻滞剂组（入院前服用β受体阻滞剂＜1个月或未服用β受体阻滞剂,共1 358例）.无复流定义为置入支架后最后一帧冠状动脉影像的血流TIMI分级＜3级.采用多因素logistic回归分析直接PCI后无复流的独立危险因素.结果 β受体阻滞剂组患者直接PCI后无复流的发生率低于非β受体阻滞剂组[13.6％ （35/257）比21.2％（289/1 358）,P=0.017].多因素logistic回归分析显示,入院前服用β受体阻滞剂（OR =0.594,95％CI：0.394～0.893,P=0.012）是直接PCI后发生无复流的保护因素,年龄≥55岁（OR=2.734,95％CI：1.959 ～ 3.817,P＜0.001）、中性粒细胞计数（OR=1.257,95％ CI：1.169 ～1.351,P＜0.001）、入院时血糖水平（OR=1.060,95％CI：1.018 ～1.103,P=0.004）、术前心功能Ⅳ级（Killip分级）（OR=3.383,95％CI：1.924 ～5.948,P＜0.001）、再灌注时间≥4h（OR=1.503,95％ CI：1.124 ～2.009,P=0.006）是直接PCI后发生无复流的独立危险因素.结论 长期服用β受体阻滞剂与急性ST段抬高型心肌梗死患者直接PCI后无复流的发生率降低有关.

Objective To investigate the impact of pre-primary percutaneous coronary intervention （PCI） β blocker use on the development of no-reflow in ST-segment elevation myocardial infarction （STEMI） patients post PCI.Methods We retrospectively evaluated 1 615 outpatients with STEMI who underwent primary primary PCI with in 12 hours from symptom onset admitted to Beijing Anzhen Hospital and Chinese people＆#39;s liberation army general hospital from January 2007 to June 2011.The study population was divided into the following 2 groups：β blocker group （pretreatment with β blockers ≥ one month before admission,n =257） and non-β blockers group （pretreatment with β blockers 〈 one month before admission or had no β blocker,n =1 358）.No-reflow was defined as TIMI grade 〈 3 in last imaging of coronary artery after stenting.Multivariable logistic regression analyses were used to identify independent predictors for the no-reflow after primary PCI.Results Incidence of the no-reflow was significantly lower in the β blocker group than in non-β blockers group （13.6% （35/257） vs.21.2% （289/1 358）,P =0.017）.Multivariable logistic regression analysis revealed that pre-PCI β blocker use was a protective predictor of the no-reflow （OR =0.594,95% CI：0.394-0.893,P =0.012）,while age ≥ 55 years old （OR =2.734,95% CI：1.959-3.817,P 〈 0.001）,high neutrophil count （OR =1.257,95% CI：1.169-1.351,P 〈 0.001）,admission plasma glucose （OR =1.060,95% CI：1.018-1.103,P =0.004）,Killip classes Ⅳ （OR =3.383,95% CI：1.924-5.948,P 〈 0.001） and reperfusion time ≥ 4 h （OR =1.503,95% CI：1.124-2.009,P =0.006） were risk factors for the development of no-reflow post PCI.Conclusion Previous long term β blockers use before STEMI is associated with lower incidence of no-reflow in patients with STEMI treated with primary PCI.