急性冠脉综合征患者介入术后慢血流事件与血浆D-二聚体水平关系

The relationship between plasma D-dimer and coronary slow flow in patients with acute coronary syndrome after percutaneous coronary intervention

目的：探讨急性冠脉综合征患者在接受介入治疗术时发生慢血流现象的危险因素及其与血浆D-二聚体水平的关系。方法回顾性分析行急诊PCI 的急性冠脉综合征患者297例。采用校正TIMI血流计帧法（ cTFC）计算各支冠状动脉的TIMI帧数。根据术中cTFC结果将患者分为CSF组和冠脉血流正常对照组， Logistic回归方法分析CSF发生的临床危险因素。 ROC曲线分析D-二聚体水平对慢血流发生的预测价值。结果共计59例（19.8％）患者出现慢血流事件，血D-二聚体水平显著高于正常对照组（P＜0.05）。 Logistic回归分析表明血D-二聚体水平（OR＝1.276，95％CI：1.132-3.224， P ＝0.012）、罪犯血管的靶病变长度（ OR ＝1.436，95％CI：0.635-1.382， P＝0.037）、血栓负荷评分（ OR＝1.108，95％CI：1.085-2.103， P＝0.018）是慢血流发生的独立危险因素。 ROC曲线表明血D-二聚体水平（ ROC曲线下面积0.783， OR＝1.502，95％CI：1.324-2.531， P＝0.005）对慢血流的发生具有预测价值（敏感度为83.5％，特异度为69.1％）。结论 D-二聚体水平升高与急性冠脉综合征患者经皮冠状动脉介入治疗术后慢血流发生密切相关，有助于预测术中慢血流的发生。

Objective To study the correlation between the risk factors of coronary slow flow phenomenon （ CSF） and the level of plasma D-dimer in patients with ACS （ acute coronary syndrome） after emergency percutaneous coronary intervention （ PCI） .Methods A total of 297 patients with ACS after PCI were enrolled for retrospective analysis.All patients were divided into CSF group and control group in the light of corrected thrombolysis in myocardial infarction （TIMI） frame count method （cTFC）.Multivariate analysis for evaluating clinical predictors of CSF was carried out using Logistic regression test and Pearson analysis to find the correlation between plasma D-dimer and cTFC.The predictive value of D-dimer level in the occurrence of coronary slow flow was determined by using receiver operating characteristic （ POC） curve analysis.Results CSF was observed in 59 cases （19.8%）.The plasma D-dimer was significantly higher in the coronary slow flow group compared with the control group （ P 〈0.05 ） .Multivariate regression analysis and Logistic regression test showed that the level of plasma D-dimer （ OR =1.276, 95%CI：1.132-3.224, P=0.012）, thrombus score （OR =1.108, 95%CI： 1.085-2.103, P =0.018） and target lesion length of culprit vessel （ OR =1.436, 95%CI： 0.635-1.382, P =0.037 ） were the risk factors of CSF.Correlation analysis showed that plasma D-dimer were positively associated with CSF. Receiver operating characteristic （ ROC ） curve analysis showed that D-dimer cutoff point at 515.3 ng/ml had a good judgment significance （ AUC 0.783, OR =1.502, 95%CI： 1.324-2.531, P =0.005）. Conclusions The increased D-dimer level is a risk factor and plays an important role in the ACS patients with the CSF phenomenon, thereby predicting no-reflow phenomenon after primary PCI in these patients.