D-二聚体/纤维蛋白原比值对老年ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术中慢血流/无复流的预测价值

Predictive value of D-dimer/fibrinogen ratio for slow flow/no-reflow during percutaneous coronary intervention in elderly patients with ST-segment elevation myocardial infarction

[目的]探讨D-二聚体/纤维蛋白原比值(DFR)对老年急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术中慢血流/无复流(SF/NRF)的预测价值。[方法]回顾性分析240例接受急诊PCI的老年STEMI患者,依据术后冠状动脉远端血流情况分为SF/NRF组(42例)和非SF/NRF组(198例),比较两组患者基线资料、介入相关指标、DFR等,分析SF/NRF的影响因素及DFR对SF/NRF的预测价值。[结果]SF/NRF组心功能Killip 2~3级、肌酸激酶同工酶峰值、心肌肌钙蛋白I峰值、D-二聚体、纤维蛋白原和DFR均显著高于非SF/NRF组(P<0.05)。SF/NRF组症状发作到首份心电图时间显著长于非SF/NRF组,术前TIMI血流0级比例显著高于非SF/NRF组(P<0.05),而有创收缩压、有创舒张压显著低于非SF/NRF组(P<0.05)。多因素回归分析显示症状发作到首份心电图时间和DFR是SF/NRF的独立预测因素。ROC曲线分析显示,当DFR>0.28时,DFR对SF/NRF的预测价值较高,曲线下面积为0.818(95%CI 0.763~0.864,P<0.01),灵敏度为73.81%,特异度为75.76%。[结论]DFR对老年STEMI患者PCI术中SF/NRF的发生具有较高的预测价值。

Aim To investigate the predictive value of D-dimer/fibrinogen ratio(DFR)for slow flow/no-reflow(SF/NRF)during percutaneous coronary intervention(PCI)in elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A retrospective analysis of 240 elderly patients with STEMI who underwent emergency PCI was performed,and the patients were divided into SF/NRF group(42 cases)and non-SF/NRF group(198 cases)according to postoperative distal coronary blood flow.The baseline data,intervention-related indicators,DFR,etc.of the two groups of patients were compared.The influencing factors of SF/NRF and the predictive value of DFR for SF/NRF were analyzed.Results Cardiac function Killip grade 2~3,peak value of creatine kinase isoenzyme MB,peak value of cardiac troponin I,D-dimer,fibrinogen and DFR in SF/NRF group were significantly higher than those in non-SF/NRF group(P<0.05).The time from symptom onset to first electrocardiogram in the SF/NRF group was significantly longer than that in the non-SF/NRF group,and the preoperative TIMI blood flow grade 0 proportion was significantly higher than that in the non-SF/NRF group(P<0.05),while invasive systolic blood pressure,invasive diastolic blood pressure were significantly lower than those in the non-SF/NRF group(P<0.05).Multivariate regression analysis showed that the time from symptom onset to first electrocardiogram and DFR were independent predictors of SF/NRF.ROC curve analysis showed that when DFR>0.28,the predictive value of DFR for SF/NRF was higher,the area under curve was 0.818(95%CI 0.763~0.864,P<0.01),the sensitivity was 73.81%,and the specificity was 75.76%.Conclusion DFR has high predictive value for the occurrence of SF/NRF during PCI in elderly STEMI patients.