冠状动脉旋磨术后发生经皮冠状动脉介入治疗相关心肌梗死的预测因子分析

Predictors of percutaneous coronary intervention related myocardial infarction after rotational atherectomy

目的旋磨是冠状动脉介入治疗过程中处理冠状动脉钙化斑块的常用方法,但部分患者术后发生经皮冠状动脉介入治疗相关心肌梗死(PMI),本研究将探索冠状动脉旋磨患者术后发生PMI的预测因子。方法接受冠状动脉旋磨及药物涂层支架植入术的冠心病患者198例,根据术后是否发生PMI分为两组,比较两组患者人口学特征、血液学检查、心脏B超、冠状动脉介入相关资料。单因素及多因素Logistic回归评价PMI的独立预测因子,采用受试者工作特征(ROC)曲线评价相关指标预测PMI的价值。结果Syntax评分、糖尿病、冠心病家族史、低密度脂蛋白胆固醇、术中慢血流与冠状动脉旋磨术后发生PMI独立相关。ROC曲线显示联合这些变量对PMI的预测价值高于Syntax评分,曲线下面积为0.832,灵敏度为0.731,特异度为0.823。结论在冠状动脉旋磨联合药物涂层支架患者中,Syntax评分是旋磨患者术后发生PMI的独立预测因子。在Syntax评分基础上增加糖尿病、冠心病家族史、低密度脂蛋白胆固醇、术中慢血流可以提高对PMI的预测价值。

Aim Rotational atherectomy(RA)is routinely used to treat calcified lesions during percutaneous coronary intervention(PCI),however,PCI related myocardial infarction(PMI)is found in some patients.This study aimed to explore the predictive factors for PMI in patients undergoing RA.Methods 198 patients enrolled in the present study were divided into two groups according to the occurrence of PMI after RA.All the patients received RA prior to drug-eluting stent implantation in severely calcified lesions.The differences of demographic characteristics,hematological profiles,echocardiography parameters and interventional characteristics were compared between the two groups.Predictors for PMI after RA were evaluated using univariable and multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the independent factors.Results Syntax scores,diabetes,family history,low density lipoprotein cholesterol and slow flow were independently associated with PMI in patients undergoing RA.Combined use of these variables provided incremental predictive value for PMI after RA,and the area under the curve was 0.832 with 0.731 sensitivity and 0.823 specificity.Conclusion Syntax scores was an independent predictor for PMI after drug-eluting stent implantation following RA.In addition,combination of diabetes,family history,low density lipoprotein cholesterol and slow flow provided additional predictive value for PMI after RA than Syntax scores alone.