急性ST段抬高型心肌梗死自发再灌注因素分析及对预后影响

Analysis of the Factors and Prognosis of Spontaneous Reperfusion in Acute ST-segment Elevation Myocardial Infarction

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者梗死相关动脉自发再灌注因素,评价自发再灌注对STEMI患者预后的影响。方法:收集2015年1月-2019年9月发病12 h内并直接行介入治疗的STEMI患者288例。根据造影结果,分为自发再灌注组(SR组,TIMI血流2、3级,70例)和非自发再灌注组(对照组,TIMI血流0、1级,218例),分析两组临床特点、实验室指标、影像资料和主要心脏不良事件(MACE)。结果:SR组年龄较低,梗死前心绞痛、长期使用他汀药物比例较高,发病到就诊时间较短,入院时血压较高(P<0.05)。SR组红细胞分布宽度(RDW)、中性粒细胞-淋巴细胞比值(NLR)、中性粒细胞百分比-白蛋白比值(NAPR)、血小板-淋巴细胞比值(PLR)、单核细胞-高密度脂蛋白比值(MHR)、脂蛋白a、纤维蛋白原、血肌酐、血尿酸、CK-MB、cTnI低于对照组(P<0.05);SR组D-二聚体水平高于对照组(P<0.05)。与对照组比较,SR组多为前壁心梗、梗死相关动脉LAD占比高,且多为单支病变,侧支循环少(P<0.05);与对照组比较,SR组平均住院时间较短,住院期间及术后6个月MACE较低,左心功能较好。多因素Logistic回归分析显示,NAPR、PLR、MHR、梗死部位、D-二聚体与SR独立相关(P<0.05)。对研究较少的三项指标进行ROC曲线分析显示:PLR、NAPR、MHR曲线下面积分别为0.762[95%CI(0.699,0.825)]、0.749[95%CI(0.689,0.809)]、0.630[95%CI(0.554,0.707)],P<0.05。结论:急性STEMI自发再灌注与多因素有关,有些因素是可控的,如长期使用他汀药物,缩短发病至就诊时间,可提高自发再灌注发生率,改善患者预后。

Objective:To investigate the factors and prognosis of spontaneous reperfusion of infarct-related artery in acute ST-segment elevation myocardial infarction (STEMI).Method:A total of 288 patients with STEMI who underwent primary percutaneous coronary intervention within 12 hours from January 2015 to September 2019 were enrolled.Patients were divided into the spontaneous reperfusion group (SR group,TIMI flow grade 2 or 3) and the non-spontaneous reperfusion (control group,TIMI flow grade 0 or 1) according to the angiography.The clinical and angiographic characteristics,laboratory indicators,and major cardiovascular events (MACE) were analyzed.Result:Compared to the control group,patients in the SR group were younger,had more angina and previous statin usage,shorter visit times and higher blood pressure at admission (P<0.05).Compared to the control group,the higher value of D-dimer in SR group,but the Red blood cell distribution width (RDW),neutrophil-lymphocyte ratio (NLR),neutrophil percentage-albumin ratio (NAPR),platelet-lymphocyte ratio (PLR) and monocyte-high density lipoprotein ratio (MHR),lipoprotein-a and fibrinogen,serum creatinine and uric acid,CK-MB,cTnI were lower (P<0.05).The SR group had the higher proportion of anterior wall infarction,left anterior descending branch (LAD) and single-branch lesion,but the collateral circulation was less (P<0.05).In the SR group,the average length of stay was shorter,and the proportion of MACE was lower in the hospital and 6 months after surgery,and the left ventricular function was better.Multivariate Logistic regression analysis showed that the NAPR,PLR and MHR,D-dimer and area of infarction were associated independently with SR (P<0.05).ROC curve was performed for three indexes less studied,the area under the PLR,NAPR and MHR curves were 0.762[95%CI (0.699,0.825)],0.749[95%CI (0.689,0.809)]and 0.630[95%CI (0.554,0.707)],P<0.05,respectively.Conclusion:Spontaneous reperfusion is associated with multiple factors,which are controllable,such as long-term use of statins,shortening the time from onset to diagnosis.Controllable factors can improve the incidence of SR and the prognosis of patients.