非ST段抬高型急性冠状动脉综合征患者经皮冠状动脉介入治疗术后慢血流或无复流相关因素分析

Analysis of factors related to slow-flow or no-reflow in patients with non-ST segment elevation acute coronary sydrome after percutaneous coronary intervention

目的探讨非ST段抬高型急性冠状动脉综合征(NSTEACS)患者经皮冠状动脉介入治疗(PCI)术后发生慢血流(SF)或无复流(NR)的相关因素。方法登录青岛市第八人民医院电子病历管理系统,收集2007年9月至2018年6月于心内科住院诊断为NSTEACS并行PCI的患者。PCI术后冠状动脉造影前向血流≤ TIMI 2级定义为发生SF或NR,作为病例组;未发生SF或NR患者作为对照组。对两组患者年龄、性别、高血压病史、2型糖尿病病史、高胆固醇血症病史、吸烟史、饮酒史、NSTEACS危险分层、血小板糖蛋白(GP)ⅡB/ⅢA受体拮抗剂的应用、冠状动脉SYNTAX积分、罪犯血管及其球囊扩张次数、高血栓负荷和PCI术前血流分级进行多因素Logistc回归分析,并应用向后法、似然比检验进行变量筛选。结果总计入选3 927例接受PCI术的NSTEACS患者,剔除信息不全者,143例患者入病例组,3 588例患者入对照组。经多因素分析结果显示,球囊扩张≥ 3次(OR=1.725,95%CI 1.211~2.358,P=0.014)、高血栓负荷(OR=1.821,95% CI 1.322~2.511,P<0.01)为发生SF或NR的危险因素,而应用GPⅡB/ⅢA受体拮抗剂(OR=0.623,95% CI 0.382~0.855,P=0.012)为抑制SF或NR发生的保护性因素。结论多次球囊扩张、高血栓负荷会增加SF或NR的发生风险,而应用GPⅡB/ⅢA受体拮抗剂可降低SF或NR发生风险。

Objective To investigate the factors related to slow-flow (SF) or no-reflow (NR)during the percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary sydrome (NSTEACS). Methods Patients diagnosed as NSTEACS who received PCI from September 2007 to June 2018 were collected through the data base of medical record management system in Qingdao Eighth People′s Hospital.The blood flow ≤ TIMI 2 grade during PCI was defined as slow-flow (SF) or no-reflow(NR). Patients with SF or NR were included into the case group and patients without SF or NR were included into the controlled group. Factors of age, gender, history of hypertension, history of type 2 diabetes, history of high cholesterol, history of smoking, history of drinking, NSTEACS risk stratification, the application of platelet glycoprotein (GP)ⅡB/ⅢA receptor antagonist, coronary artery SYNTAX score, culprit blood vessels, times of balloon dilatation, the burden of thrombus and the preoperative TIMI grade of blood flow were analyzed by multivariate Logistic regression. Then, variables screening was performed through backward method and likelihood ratio test. Results A total of 3 927 patients with NSTEACS receiving PCI were enrolled. After patients with incomplete information were eliminated, 143 patients were admitted to the case group and 3 588 patients were admitted to the control group. After the analysis of multivariate Logistic regression and variables screening, it was showed that times of balloon dilatation ≥ 3 (OR=1.725, 95% CI 1.211-2.358, P=0.014) and high burden of thrombus (OR=1.821, 95%CI 1.322-2.511, P<0.01) were the risk factors of SF or NR, while the application of GPⅡB/ⅢA receptor antagonist (OR=0.623, 95%CI 0.382-0.855, P=0.012) was the protective factor of SF or NR. Conclusions Multiple balloon dilatation and high burden of thrombus increased the risk of SF or NR, while the application of GPⅡB/ⅢA receptor antagonists could inhibit the occurrence of SF or NR.