术前休克指数对急性心肌梗死患者行急诊介入治疗无复流现象影响的临床研究

Preoperative shock index is associated with no reflow phenomenon in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

目的:探讨术前休克指数(SI)对行急诊冠状动脉介入治疗(PPCI)的ST段抬高型急性心肌梗死(STEMI)患者无复流现象(NRP)的影响。方法:根据入选标准及排除标准,回顾性分析行PPCI的STEMI患者358例,根据手术过程中冠状动脉血流情况,分为冠状动脉血流正常组和NRP组,比较两组患者基线的临床情况,比较两组患者住院期间临床不良事件情况,探讨NRP的预测因素。结果:NRP的发生率为20.1%。NRP组在SI[(0.70±0.13)vs.(0.65±0.11),P=0.001]、SI≥0.7(51%vs. 36%,P=0.014)等指标明显高于血流正常组。NRP组在术前随机血糖、入院时Killp3-4级、入院白细胞升高等指标高于血流正常组(P<0.05)。NRP组高血栓负荷方面明显高于血流正常组(56%vs. 37%,P=0.004)。Logistic回归分析显示术前SI≥0.7是NRP的危险因素(OR=2.014,95%CI:1.126~4.105,P=0.021)。此外,术前随机血糖、入院时Killp3-4级、入院白细胞升高、高血栓负荷亦是NRP的危险因素(P<0.05)。NRP组患者有更高的复合终点事件的发生率(27.8%vs.13.2%,P=0.003)。结论:对于行PPCI的STEMI患者,NRP普遍存在,术前SI是NRP的危险因素。

Objective: To explore whether shock index(SI) is associated with no reflow phenomenon(NRP)in ST-segment elevation myocardial infarction(STEMI)subjects undergoing primary percutaneous coronary intervention(PPCI). Methods: We enrolled 358 patients with STEMI underwent PPCI. The participants were divided into normal flow group(n=286) and NRP group(n=72) according to cine angiograms recorded during the period of PCI. Baseline clinical characteristics, biochemical parameters, preoperative management of antithrombotic therapy, and baseline angiography data were collected. Results: Incidence of NRP was 20.1%. Preoperative shock index(SI) [(0.70±0.13) vs.(0.65±0.11),P=0.001]and SI≥0.70(51% vs. 36%,P=0.014) were significantly different between patients with and NRP. Moreover, random blood glucose, Killip classification 3-4 grade on admission, elevation of white blood cells(WBC) and high thrombus burden on initial angiography were significantly different between patients with and without NRP(P<0.05).Logistic multivariate analysis revealed that SI≥0.70(OR=2.014,95%CI:1.126-4.105,P=0.021), random blood glucose, Killip classification 3-4 grade on admission, elevation of WBC and high thrombus burden were independent predictors for coronary NRP. The patients with NRP experienced a significantly higher incidence of composite major adverse cardiac events(MACE)(27.8% vs. 13.2%,P=0.003)than the patients without NRP. Conclusions: NRP is a common finding in STEMI patients undergoing PPCI. SI could be as a predictor for NRP in STEMI patients undergoing PPCI.