D-二聚体与老年急性心肌梗死冠状动脉介入术后无复流的相关性研究

Relationship between plasma D-dimer level and no-reflow in elderly acute ST-elevation myocardial infarction patients after primary PCI

目的探讨D-二聚体水平与老年急性ST段抬高型心肌梗死(ST-elevated myocardiol infarction,STEMI)患者直接PCI后无复流的关系。方法连续性入选老年急性STEMI接受直接PCI患者124例,根据术后即刻血流TIMI分级和心肌染色分级将患者分为正常血流组84例和无复流组40例。比较2组D-二聚体水平,并探讨D-二聚体水平与术后无复流发生的关系。结果无复流组患者D-二聚体水平明显高于正常血流组[0.91(0.55,1.41)mg/L vs 0.46(0.33,0.96)mg/L,P=0.00]。多元logistic回归分析显示,D-二聚体水平是介入术后无复流发生的独立危险因素(OR=4.18,95%CI:1.18~14.7,P=0.026)。ROC曲线分析显示,术前D-二聚体界值为0.74mg/L时,预测术后无复流发生的敏感性为70.0%,特异性为72.6%。血浆D-二聚体>0.74mg/L患者的无复流发生率明显高于血浆D-二聚体≤0.74mg/L患者无复流发生率(54.0%vs 17.5%,P=0.00)。结论老年急性STEMI患者接受直接PCI后,冠状动脉无复流发生与D-二聚体水平相关。

Objective To study the relationship between plasma D-dimer level and no-reflow in elderly acute STEMI patients after primary PCI.Methods One hundred and twenty-four elderly acute STEMI patients who underwent primary PCI were divided into reflow group（n=84）and no-reflow group（n=40）according to their immediate TIMI flow grade.The relationship between plasma D-dimer level and no-reflow in elderly acute STEMI patients was analyzed after primary PCI.Results The plasma D-dimer level was significantly higher in no reflow group than in reflow group[0.91（0.55,1.41）mg/L vs 0.46（0.33,0.96）mg/L,P=0.00].Multivariate logistic regression analysis showed that plasma D-dimer level was an independent risk factor for no-reflow in elderly acute STEMI patients after primary PCI（OR=4.18,95%CI：1.18-14.7,P=0.026）.ROC curve analysis revealed that the preoperative plasma D-dimer level could predict no reflow in elderly acute STEMI patients when its cutoff was 0.74 mg/L with a sensitivity of 70%and a specificity of 72.6%.The incidence of no-reflow was significantly higher when the planma D-dimer level was〉0.74 mg/L than when the planma D-dimer level was≤0.74 mg/L in elderly acute STEMI patients（54.0%vs 17.5%,P=0.00）.Conclusion No-reflow in coronary artery is related with plasma D-dimer level in elderly acute STEMI patients after primary PCI.