休克指数与修正休克指数对急性ST段抬高型心肌梗死患者急诊PCI治疗中慢血流/无复流的预测价值

Predictive Values of Shock Index and Modified Shock Index for Slow Flow/No Reflow in Patients with Acute ST Segment Elevation Myocardial Infarction undergoing Emergency Percutaneous Coronary Intervention

目的探讨休克指数(shock index,SI)与修正休克指数(modified shock index,MSI)对急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中出现慢血流/无复流现象的预测价值。方法回顾性分析2016年1月至2020年3月在佛山市南海区人民医院就诊并行直接PCI治疗的急性STEMI患者,根据PCI治疗影像学结果将患者分为正常组和慢血流/无复流组,分别计算SI及MSI,比较两组患者间的基线资料,通过受试者工作特征曲线(receiver operating characteristic curve,ROC)分析SI、MSI对急性STEMI患者急诊PCI治疗中慢血流/无复流发生的预测价值。结果共收集患者834例,发生慢血流/无复流139例(16.67%),ROC分析结果显示SI、MSI的最佳截断值分别为0.677、0.899,其预测慢血流/无复流发生的曲线下面积分别为0.654(CI 95%:0.597~0.710,P<0.001)、0.650(CI 95%:0.596~0.706,P<0.001),敏感度为45.3%、43.2%,特异度为74.9%、77.0%,阳性预测值为26.7%、27.4%,阴性预测值为87.2%、87.0%。结论SI、MSI不适合作为慢血流/无复流发生的诊断标准,但可以考虑作为排除指标辅助判断不发生慢血流/无复流的可能,而且不同“罪犯血管”所致的STEMI均可使用该截断值。

Objectives To study the predictive values of shock index(SI)and modified shock index(MSI)for slow flow/no reflow in patients with acute ST segment elevation myocardial infarction(STEMI)undergoing emergency percutaneous coronary intervention(PCI).Methods Data of patients with acute STEMI undergoing emergency PCI in Nanhai District People′s Hospital from January 2016 to March 2020 were collected retrospectively.The patients were divided into normal group and slow flow/no reflow group according to the PCI imaging data.SI and MSI of the two groups were calculated.The general information was compared between the two groups.Predictive values of SI and MSI for slow flow/no reflow were analyzed by drawing the receiver operating characteristic curve(ROC).Results Totally 834 patients were collected and 139(16.67%)of them had slow flow/no reflow.The optimal cut off value of SI and MSI were 0.677 and 0.899.The area under curve(AUC)of SI and MSI for predicting slow flow/no reflow were 0.654(CI 95%:0.597-0.710,P<0.001)and 0.650(CI 95%:0.596-0.706,P<0.001),the sensibility were 45.3%and 43.2%,the specificity were 74.9%and 77.0%,the positive predictive value were 26.7%and 27.4%,the negative predictive value were 87.2%and 87.0%.Conclusions SI or MSI were not good as a diagnostic criteria for slow flow/no reflow,but can be used as an exclusive index for clinicians to judge the possibility of slow flow/no reflow and no matter which infarct related artery is the cause of STEMI.