急性STEMI患者急诊PCI术后无复流的相关因素分析

Related Factors of No Reflow after Emergency Percutaneous Coronary Intervention in Patients with Acute ST Elevation Myocardial Infarction

目的:探讨急性ST段抬高型心肌梗死(Acute ST elevation myocardial infarction,STEMI)患者急诊经皮冠脉介入治疗术(Percutaneous coronary intervention,PCI)后无复流的相关因素。方法:选取于2018年5月—2019年6月期间因STEMI于我院行急诊PCI治疗的患者520例作为研究对象。根据术后是否发生无复流,将患者分为无复流组(53例)和正常血流组(467例)。对比两组患者的临床基线资料、术前检查检验结果和手术情况。并行单因素和多因素Logistic回归分析。结果:无复流组与正常血流组相比,存在统计学差异(P<0.05)的指标包括:发病至就诊时间、年龄、血栓负荷、术前是否服用负荷量替格瑞洛、术中是否使用盐酸替罗非班、支架数目、支架长度等。多因素Logistic回归分析显示,年龄、发病至就诊时间、血栓负荷是导致PCI术后无复流的独立危险因素。结论:STEMI患者PCI术后无复流发生率较高。年龄、发病至就诊时间及血栓负荷可作为预测STEMI患者急诊PCI术中发生无复流的独立危险因素,而糖尿病、高血压、吸烟等冠心病的常见危险因素与无复流未见相关性。

Objective:To explore the related factors of no reflow after acute percutaneous coronary intervention(PCI)in patients with acute ST elevation myocardial infarction(STEMI).Methods:A total of 520 STEMI patients in our hospital for PCI treatment between May 2018 and June 2019 were selected as the study subjects.The patients were divided into non-reflow group(53 cases)and normal blood flow group(467 cases)according to whether there was no reflow after surgery.Compared the clinical baseline data,preoperative examination results and surgical conditions of the two groups.And took parallel univariate and multivariate Logistic regression analysis.Results:Compared with the normal blood flow group,the non-reflow group has statistically significant differences(P<0.05)in the indicators include:time from onset to consultation,age,thrombus load,whether to take loading dose ticagrelor before surgery,whether to use tirofiban hydrochloride during surgery,number of stents,length of stent.Multivariate Logistic regression analysis showed that the age,time from onset to consultation,thrombus load were independent risk factors leading to no reflow after PCI(P<0.05).Conclusion:STEMI patients have a higher incidence of no reflow after PCI.Age,time from onset to consultation and thrombus load can be used as independent risk factors for predicting no-reflow during emergency PCI in STEMI patients.There was no correlation between the common risk factors of coronary heart disease such as diabetes,hypertension,smoking and no reflow.