主动脉瓣硬化与急性ST段抬高型心肌梗死患者PCI术后无复流的关系

Relationship between aortic valve sclerosis and no-reflow after PCI in patients with acute ST segment elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死(STEMI)患者主动脉瓣硬化(AVS)与经皮冠状动脉介入治疗(PCI)后无复流的关系,并对发生无复流的影响因素进行分析。方法连续纳入2019年1月至2019年12月本院收治的117例初诊急性STEMI患者,均接受急诊冠状动脉造影和PCI治疗。根据是否发生PCI术后无复流、是否存在AVS对患者进行分组。比较各组患者的临床资料,并通过多因素Logistic回归分析影响急性STEMI患者PCI术后发生无复流的因素。结果本研究中,28例患者PCI术后发生无复流(无复流组),89例未发生(正常血流组);23例患者的心脏超声提示AVS(AVS组),94例未提示AVS(非AVS组)。无复流组患者的年龄、AVS占比及SYNTAX积分高于正常血流组,吸烟占比低于正常血流组,差异具有统计学意义(P<0.05)。AVS组患者PCI术后无复流发生率显著高于非AVS组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、AVS、SYNTAX积分是影响急性STEMI患者PCI术后发生无复流的独立危险因素(P<0.05)。结论在行PCI术的急性STEMI患者中,AVS与PCI术后无复流关系密切,因此,临床上针对STEMI合并AVS患者应给予有效干预。

Objective To explore the relationship between aortic valve sclerosis(AVS)and no-reflow after percutaneous coronary intervention(PCI)in patients with acute ST segment elevation myocardial infarction(STEMI),and analyze the influencing factors of no-reflow.Methods A total of 117 newly diagnosed acute STEMI patients admitted in our hospital from January 2019 to December 2019 were enrolled in this study.All patients received emergency coronary angiography and PCI therapy.The patients were grouped according to whether there was no-reflow after PCI and whether there was AVS.The clinical data of each group were compared,and the factors influencing no-reflow after PCI were analyzed by multivariate Logistic regression.Results In this study,28 patients had no-reflow after PCI(no-reflow group),89 patients did not(normal blood flow group);23 patients showed AVS(AVS group)and 94 patients did not(non-AVS group)by echocardiography.The age,AVS proportion and SYNTAX score of the no-reflow group were higher than those of the normal blood flow group,and smoking proportion was lower than that of the normal blood flow group,and the differences were statistically significant(P<0.05).The incidence of no-reflow in the AVS group was significantly higher than that in the non-AVS group,and the difference was statistically significant(P<0.05).The multivariate Logistic regression analysis showed that age,AVS and SYNTAX score were independent risk factors for no-reflow after PCI in patients with acute STEMI(P<0.05).Conclusion In patients with acute STEMI undergoing PCI,AVS is closely related to no-reflow after PCI.Therefore,effective intervention should be given to STEMI patients with AVS.