血清同型半胱氨酸水平对老年STEMI患者PCI后冠状动脉血流的影响

Effect of serum homocysteine level on coronary blood flow in elderly pati ents with STEMI after PCI

目的:探讨血清同型半胱氨酸(HCY)水平对老年急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后冠状动脉血流的影响。方法:回顾性分析2019年12月至2021年10月于中山大学附属第三医院粤东医院行PCI的288例老年STEMI患者的临床资料。依据这些患者血清HCY的水平将其分为高HCY组与正常HCY组。对比两组患者术中罪犯血管支架释放后的TIMI血流分级、围手术期并发症的发生率及冠状动脉病变数量。结果:术中支架释放后,高HCY组患者罪犯血管TIMI 0级、1级、2级的发生率均高于正常HCY组患者,差异有统计学意义(P<0.05)。高HCY组患者术后再发心梗、支架内血栓再形成和心律失常的发生率均高于正常HCY组患者,差异有统计学意义(P<0.05)。正常HCY组患者单支冠状动脉病变的发生率高于高HCY组患者,差异有统计学意义(P<0.05)。高HCY组患者三支冠状动脉病变、合并冠状动脉左主干(LM)病变的发生率均高于正常HCY组患者,差异有统计学意义(P<0.05)。结论:老年STEMI患者PCI后冠状动脉血流的恢复、冠状动脉病变支数及术后并发症的发生率均与其血清HCY的水平有显著相关性,临床上应对血清HCY水平升高的老年STEMI患者进行针对性治疗,以提升其PCI的效果,改善其预后。

Objective:To investigate the effect of serum homocysteine(HCY)level on coronary blood flow after percutaneous coronary intervention(PCI)in elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:The clinical data of 288 elderly patients with STEMI who underwent PCI in Yuandong Hospital,the Third Affiliated Hospital of Sun Yat-sen University from December 2019 to October 2021 were retrospectively analyzed.According to the serum HCY level,these patients were divided into high HCY group and normal HCY group.The TIMI blood flow grade,the incidence of perioperative complications and the number of coronary artery lesions were compared between the two groups.Results:After stent release,the incidences of TIMI grade 0,1,and 2 in the high HCY group were higher than those in the normal HCY group,and the differences were statistically significant(P<0.05).The incidences of recurrent myocardial infarction,stent thrombosis and arrhythmia in the high HCY group were higher than those in the normal HCY group,and the differences were statistically significant(P<0.05).The incidence of single coronary artery disease in normal HCY group was higher than that in high HCY group,and the difference was statistically significant(P<0.05).The incidences of three-vessel coronary artery disease and left main coronary artery(LM)disease in the high HCY group were higher than those in the normal HCY group,and the differences were statistically significant(P<0.05).Conclusions:The recovery of coronary blood flow,the number of coronary artery lesions and the incidence of postoperative complications in elderly STEMI patients after PCI are significantly correlated with the serum HCY level.Clinically,targeted treatment should be given to elderly STEMI patients with elevated serum HCY level to improve the effect of PCI and their prognosis.