入院休克指数与急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗术中冠状动脉无复流的相关性分析

The value of shock index on admission to predict no-refl ow in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

目的探讨入院休克指数对急性ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入治疗(PCI)术中冠状动脉无复流现象的影响。方法采用回顾性横断面分析,选取2017年1月至2019年10月首次就诊于宁夏医科大学总医院心内科并行直接PCI术的641例STEMI患者,根据PCI术中血管造影结果,将入组患者分为无复流组和完全灌注组,对比分析两组心血管病危险因素、血液学指标及血管造影基线数据,并利用多因素Logistic回归分析模型评估休克指数与无复流是否相关,绘制受试者工作特征(ROC)曲线评价其预测价值。结果641例患者分为无复流组104例与完全灌注组537例。多因素Logistic回归分析显示,休克指数(OR 4.740,95%CI 1.078~20.849,P=0.039)、血肌酐(OR 1.013,95%CI 1.003~1.023,P=0.007)、入院收缩压(OR 0.967,95%CI 0.936~0.988,P=0.036)是STEMI患者直接PCI术后发生冠状动脉无复流的危险因素。纳入完全灌注组与无复流组的休克指数进行ROC曲线分析,结果显示,休克指数预测冠状动脉无复流的曲线下面积为0.635(95%CI 0.577~0.692,P<0.001),灵敏度为76.0%,特异度为56.5%,具有一定的预测价值。结论入院休克指数≥0.635可能是STEMI患者直接PCI术中冠状动脉无复流的危险因素,对预测患者PCI术中冠状动脉无复流具有一定价值。

Objective To explore the relationship of Shock Index for no-reflow of coronary artery after primary percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 641 patients with STEMI who were treated in General Hospital of Ningxia Medical University from January 2017 to October 2019 were enrolled.According to coronary angiography,the patients were divided into no-refl ow group and complete perfusion group.Cardiovascular disease risk factors,hematological indicators and baseline data of angiography were collected and compared,multivariate Logistic regression was used to evaluate whether shock index is independently related to no-reflow,and ROC was used to evaluate the predictive performance.Results Among the 641 STEMI patients,104 had no-refl ow and 537 had complete perfusion.Multivariate Logistic regression showed,shock index(OR 4.740,95%CI 1.078–20.849,P=0.039),serum creatinine(OR 1.013,95%CI 1.003–1.023,P=0.007),systolic blood pressure(OR 0.967,95%CI 0.936–0.988,P=0.036)were risk factors of no-reflow of coronary artery. The ROC curve showed that the area under the curve of SI in predicting no-reflow of coronary artery was 0.635(95%CI 0.577–0.692,P<0.001)with sensitivity and specifi city of 76.0% and 56.5%,respectively.Conclusions Shock index≥0.635 on admission may be a risk factor,which has certain diagnostical value for predicting on no-refl ow after PCI.