急性ST段抬高型心肌梗死合并射血分数保留的心力衰竭患者急诊经皮冠状动脉介入治疗术中无复流的影响因素分析

Predictive factors of no flow during percutaneous coronary intervention in patients of heart failure with preserved ejection fraction with ST-segment elevation myocardial infarction

目的 探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)合并射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者行急诊经皮冠状动脉介入术(primary percutaneous coronary intervention,PPCI),术中发生无复流的影响因素.方法 连续选取2017年1月至2019年1月就诊于首都医科大学附属北京安贞医院急诊科并行急诊PCI治疗的STEMI合并HFpEF患者326例,按照急诊PCI术中血流情况,分为正常复流组(255例)和无复流组(71例).比较两组的临床资料,分析无复流发生的影响因素.结果 合并HFpEF的STEMI患者,PPCI术后无复流发生率为21.8%(71/326),两组之间急诊收缩压(SBP)[(113.75±23.27)mm Hg比(127.84±34.58)mm Hg,P=0.046]、即刻血糖水平[(14.32±6.75)mmol/L比(9.17±7.50)mmol/L,P=0.038]、发病到再灌注时间[(118.07±41.35)min比(9.74±39.23)min,P=0.037]、球囊扩张次数(12.5%比10.1%,P=0.042)差异均有统计学意义(P<0.05);经多因素Logistic回归分析显示,急诊SBP(OR=1.089,95%CI 0.746~18.247,P=0.031)、球囊扩张次数(OR=1.980,95%CI 0.883~1.087,P=0.039)、发病至再灌注时间(OR=2.985,95%CI 0.064~0.982,P=0.048)是急诊PCI术中无复流发生的危险因素.结论 合并EFpHF合并STEMI患者行PPCI后无复流发生与入院收缩压、球囊扩张次数、发病至再灌注时间具有相关性.

Objective To investigate the predictive factors of no flow during percutaneous coronary intervention in patients of heart failure with preserved ejection fraction(EFpHF)with ST-segment elevation myocardial infarction(STEMI).Methods Data of STEMI patients of EFpHF treated with PPCI were collected from Jan 2017to Jan 2019 and the patients were divided into the no-flow group(n=71)and the normal blood flow group(n=255)according to the condition of thrombolysis in myocardial infarction(TIMI)flow grade and TIMI myocardial perfusion grade(TMPG).Compared to analyze the risk factors related to no-retlow.Multivariable Logistic regression analysis was used to identify the independent no-reflow predictors of the model group and then we designed a score according to the odds ratio on Logistic regression analysis.Results The no-reflow phenomenon was found in 71(21.8%)of 326 patients.Compared to the normal flow group,the SBP](113.75±23.27)mmHgvs.(127.84±34.58)mm Hg,P=0.046],Glu[(14.32±6.75)mmol/L vs.(9.17±7.50)mmol/L,P=0.038],pain to balloon time[(118.07±41.35)min vs.(99.74±39.23)min,P=0.037]and times of balloon dilatation(12.5%vs.10.1%,P=0.042)were significantly different.Multivariate Logistic regression analysis demonstrated that SBP(R=1.089,95%CI 0.746-18.247,P=0.031),times of balloon dilatation(OR=1.980,95% CI 0.883-1.087,P=0.039)and pain to balloon time(R=2.985,95%CI,0.064-0.982,P=0.048)were independent predictors of no-reflow in the EFpHF patients with STEMI after PCI.Conclusion This study demonstrates that SBP,times of balloon dilatation and pain to balloon time were independent predictors of noreflow in the EFpHF patients with STEMI after PCI.