急性心肌梗死病人急诊经皮冠状动脉介入治疗术后冠脉慢血流-无血流现象的预测因素

Predictive factors for no or slow reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention

目的分析急性心肌梗死(AMI)病人行经皮冠状动脉介入治疗术(PCI)后发生慢血流-无血流现象的相关危险因素,并探讨其对慢-无复流现象的预测价值。方法 278例ST段抬高的AMI病人入院确诊后即行急诊PCI术,依据PCI造影结果按TIMI分级分为慢-无血流组和正常对照组。比较2组病人的一般情况、PCI术中情况、急诊及PCI术后1周的相关实验室检查结果,采用Logistic回归分析慢-无血流的影响因素。结果所有病人中,40例(14. 4%) PCI后出现了慢-无血流现象,238例(85. 6%)血流正常。单因素分析显示,2组病人的血清超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)和肌钙蛋白(cardiac troponin I,c Tn-I)差异有统计意义(P<0. 01);病人心肌梗死面积、梗死相关动脉(IRA)术前血流TIMI分级、门球时间、梗死后心功能分级、心肌梗死前心绞痛(梗死前的缺血预适应)等方面差异具有统计学意义(P<0. 01)。多因素Logistic回归分析结果显示,血清hs-CRP和c Tn-I水平、心肌梗死面积、门球时间、心功能分级、梗死前心绞痛及IRA术前血流TIMI分级与AMI病人急诊PCI术后慢-无血流现象的发生明显相关。结论血清hs-CRP和c Tn-I浓度、心肌梗死面积、门球时间、心功能分级、IRA术前血流TIMI分级、梗死前心绞痛是AMI病人急诊PCI术发生慢-无血流现象的预测因素。

Objective To study the risk factors for no or slow reflow in the patients with acute myocardial infarction( AMI) after primary percutaneous coronary intervention( PCI). Methods A total of 278 patients diagnosed with ST-segment elevation myocardial infarction undergoing primary PCI were selected. All patients were divided into no or slow reflow group and normal control group according to coronary artery TIMI grade in PCI procedure. The clinical data between the two groups were compared,including marital status,high-sensitive C-reactive protein( hs-CRP),cardiac troponin I( cTn-I),area of myocardial infarction,time of door-to-balloon,Killip degree of heart function,preinfarction angina,and TIMI degree of blood in infarct-related artery( IRA). Results After primary PCI,40 patients( 14. 4%) showed no or slow reflow and 238 patients( 85. 6%) showed normal coronary flow. Univariate analysis showed that there were significant differences in serum levels of hs-CRP and cTn-I,area of myocardial infarction,time of door-to-balloon,Killip degree of heart function,preinfarction angina,and TIMI degree of blood in IRA between the two groups( P<0. 01). Multivariate Logistic regression analysis also demonstrated significant differences in the above factors( P< 0. 01). Conclusions Serum concentrations of hs-CRP and c Tn-I,aera of myocardial Infarction,time of door-to-balloon,heart function,preinfarction angina and TIMI degree in IRA are predictive factors for no or slow reflow in AMI patients after PCI.