CHA_(2)DS_(2)-VASc评分联合术前血流分级与老年急性心肌梗死术后无复流的关系

Relationship between CHA_(2)DS_(2)-VASc score combined with TIMI flow before PPCI and no reflow in elderly acute STEMI patients after PPCI

目的探讨评估CHA_(2)DS_(2)-VASc评分联合术前TIMI血流对老年急性ST段抬高型心肌梗死(STEMI)患者行急诊PCI(PPCI)术后无复流的预测价值。方法回顾性分析行PPCI的老年STEMI患者186例;术前高血流(术前TIMI≥1级)70例和低血流(术前TIMI 0级)116例,并依据术后TIMI血流分为无复流组(TIMI≤2级)36例和复流组(TIMI=3级)150例。采用logistic回归分析危险因素。结果无复流组CHA_(2)DS_(2)-VASc评分、低血流比例明显高于复流组[(3.97±1.65)分vs(2.53±1.47)分,P=0.000;80.6%vs 58.0%,P=0.012]。CHA_(2)DS_(2)-VASc评分联合术前TIMI血流预测无复流的曲线下面积为0.776(95%CI:0.693~0.859,P<0.01),低血流患者术后无复流、支架长度、血栓抽吸、术中使用替罗非斑、室性心动过速/心室颤动、起搏器置入比例明显高于高血流患者(P<0.05,P<0.01)。多因素分析显示,CHA_(2)DS_(2)-VASc评分、血小板计数、TC/HDL-C、低血流是术后无复流发生的独立预测因素(P<0.05,P<0.01)。结论CHA_(2)DS_(2)-VASc评分联合术前TIMI血流预测老年STEMI患者PPCI术后无复流发生更有效。

Objective To study the value of CHA_(2)DS_(2)-VASc score combined with TIMI flow before PPCI in predicting no relow in elderly acute STEMI patients.Methods One hundred and eighty-six elderly acute STEMI patients who underwent PPCI were divided into no reflow group(n=36)and reflow group(n=150)according to their TIMI flow after PPCI or into high flow group(n=70)and low flow group(n=116)according to their TIMI flow before PPCI.The risk factors for no reflow in elderly acute STEMI patients after PPCI were analyzed by multivariate logistic regression analysis.Results The CHA_(2)DS_(2)-VASc score and the rate of low flow were significantly higher in no reflow group than in reflow group(3.97±1.65 vs 2.53±1.47,P=0.000,80.6%vs 58.0%,P=0.012).The AUC for CHA_(2)DS_(2)-VASc score combined with TIMI flow before PPCI in predicting no reflow in elderly acute STEMI patients after PPCI was 0.776(95%CI:0.693~0.859,P<0.01).The rate of no reflow,thrombobus aspiration,use of tirofiban during PCI,ventricular tachycardia/ventricular fibrillation,and implanted pacemakers was significantly higher and the stent was significantly longer in low flow group than in high flow group(P<0.05,P<0.01).The CHA_(2)DS_(2)-VASc score,platelet count,TC/HDL-C and low flow were the independent predictors of no reflow in elderly acute STEMI patients after PPCI(P<0.05,P<0.01).Conclusion CHA_(2)DS_(2)-VASc score combined with TIMI flow before PPCI is more effective than CHA_(2)DS_(2)-VASc score alone in predicting no reflow in elderly STEMI patients after PPCI.