Clinical and procedural predictors of no-ref low in patients with acute myocardial infarction after primary percutaneous coronary intervention

BACKGROUND: The treatment of acute myocardial infarction(AMI) is thought to restore antegrade blood flow in the infarct-related artery(IRA) and minimize ischemic damage to the myocardium as soon as possible. The present study aimed to identify possible clinical predictors for no-refl ow in patients with AMI after primary percutaneous coronary intervention(PCI).METHODS: A total of 312 consecutive patients with AMI who had been treated from January 2008 to December 2010 at the Cardiology Department of East Hospital, Tongji University School of Medicine were enrolled in this study. Inclusion criteria were:(i) patients underwent successfully primary PCI within 12 hours after the appearance of symptoms; or(ii) patients with ischemic chest pain for more than 12 hours after a successful primary PCI within 24 hours after appearance of symptoms. Exculsion criteria were:(i) coronary artery spasm;(ii) diameter stenosis of the culprit lesion was ≤50% and coronary blood f low was normal;(iii) patients with severe left main coronary or multivessel disease, who had to require emergency revascularization. According to thrombolysis in myocardial infarction(TIMI), the patients were divided into a reflow group and a no-reflow group. The clinical data, angiography f indings and surgical data were compared between the two groups. Univariate and multivariate logistic regressions were used to determine the predictors for no-ref low.RESULTS: Fifty-four(17.3%) of the patients developed NR phenomenon after primary PCI. Univariate analysis showed that age, time from onset to reperfusion, systolic blood pressure(SBP) on admission, Killip class of myocardial infarction, intra-aortic balloon pump(IABP) use before primary PCI, TIMI flow grade before primary PCI, type of occlusion, thrombus burden on baseline angiography, target lesion length, reference luminal diameter and method of reperfusion were correlated with no-reflow(P<0.05 for all). Multiple logistic regression analysis identified that age >65 years [OR=1.470, 95% confi dence interval(CI) 1.460–1.490, P=0.007], long time from onset to reperfusion >6 hours(OR=1.270, 95%CI 1.160–1.400, P=0.001), low SBP on admission <100 mmHg(OR=1.910, 95%CI 1.018–3.896, P=0.004), IABP use before PCI(OR= 1.949, 95%CI 1.168–3.253, P=0.011), low(≤1) TIMI fl ow grade before primary PCI(OR=1.100, 95%CI 1.080–1.250, P<0.001), high thrombus burden(OR=1.600, 95%CI 1.470–2.760, P=0.030), and long target lesion(OR=1.948, 95%CI 1.908–1.990, P=0.019) on angiography were independent predictors of no-refl ow.CONCLUSION: The occurrence of no-refl ow after primary PCI for acute myocardial infarction can predict clinical, angiographic and procedural features.

Value of Platelet to Lymphocytes Ratio in Predicting Angiographic Reflow after Primary Percutaneous Coronary Intervention in STEMI Patient

Background: Acute myocardial infarction is a leading cause of death worldwide nowadays and treatment of choice is primary percutaneous coronary intervention (PCI). No reflow is a complication that increases mortality and morbidity post intervention and one of its predictors is platelet lymphocyte ratio. Aim of Study: To assess relation between admission platelet to lymphocyte ratio (PLR) and angiographic reflow after primary PCI in acute ST elevation myocardial infarction (STEMI). Patients and Methods: This is a prospective study that was conducted from May 2017 to May 2018 at Cardiology Department, Menoufia University Hospital. Sixty patients presented with ST-elevation myocardial infarction who were eligible for primary PCI were enrolled in the study. According to TIMI flow post intervention, patients were arranged into 2 groups: Group 1 (Normal Reflow) included thirty patients with post intervention TIMI flow III and Group 2 (NO Reflow) included thirty patients with post intervention TIMI flow (0, I, II). Comparison between both groups was done regarding platelet lymphocyte ratio (PLR). Result: PLR was significantly higher in patients with coronary no reflow than in patients with normal reflow with a P-value of , timing interval between onset of chest pain to time of intervention and thrombus grading was significantly higher in patients with no reflow than in patients with normal reflow. Conclusion: Pre-intervention PLR is an independent predictor of slow flow/no reflow following PPCI in patient with acute STEMI.

Sodium nitroprusside injection immediately before balloon inflation during percutaneous coronary intervention

BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whether conventional target intracoronary administration of sodium nitroprusside immediately before balloon inflation can reduce the incidence of no reflow and slow flow,which are defined as thrombolysis in myocardial infarction flow grade≤II during PCI.METHODS A retrospective study was conducted in 740 patients with coronary artery disease admitted to Gansu Provincial Hospital of Traditional Chinese Medicine between January 2016 and October 2020.Among them,360 patients receiving sodium nitroprusside immediately before balloon inflation during PCI were enrolled in an experimental group between January 2019 and October 2020 and 380 patients receiving sodium nitroprusside after incident no reflow and slow flow during PCI were enrolled in a control group between January 2016 and January 2019.The occurrence of no reflow and slow flow was compared between the two groups and left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were detected 1 mo after the operation.RESULTS After treatment,the proportion of patients with thrombolysis in myocardial infarction flow grades 0 to II was lower in the experimental group than in the control group(P<0.05).At 1 mo after treatment,LVEDD was lower and LVEF was higher in the experimental group than in the control group(P<0.05).In terms of incidence of adverse cardiovascular events within 1 mo after treatment,in the experimental group,malignant arrhythmia occurred in three patients,intractable myocardial ischemia in three,congestive heart failure in four,and recurrent myocardial infarction in five;one patient died.In the control group,malignant arrhythmia occurred in eight patients,intractable myocardial ischemia in five,congestive heart failure in seven,and recurrent myocardial infarction in 14;two patients died.The incidence of adverse cardiovascular events was 4.4%in experimental group which was lower than that of the control group at 1 mo after operation(9.5%;P<0.05).CONCLUSION Administration of sodium nitroprusside into target vessels immediately before balloon inflation can significantly reduce the incidence of no reflow and slow flow,improve LVEDD and LVEF,and reduce the incidence of adverse cardiovascular events in patients treated by PCI.It is worthy of clinical promotion.

Effect of Chinese Medicine on No or Slow Reflow after Percutaneous Coronary Intervention in Myocardial Infarction Patients: A Systematic Review and Meta-Analysis

Objective:To systematic review the effect of Chinese medicine(CM)on no or slow reflow after percutaneous coronary intervention(PCI)in myocardial infarction(MI)patients.Methods:The Pub Med,EMBASE databases,Cochrane Central Register of Controlled Trials(CENTRAL),Web of Science,China National Knowledge Infrastructure(CNKI),Chinese BioMedical Literature Database(CBM),Wanfang Knowledge Service Platform(Wanfang Database)and Chinese Scientific Journal Database(VIP)were searched up to December 2017.Randomized controlled trials(RCTs)which evaluated the effect of CM therapies on no or slow reflow after PCI in MI patients were included.The primary outcome was the effect of reperfusion.Secondary outcomes were left ventricular ejection fraction,incidence of major adverse cardiovascular events and adverse effect.Results:Ten RCTs covering 814 patients were included.Two studies revealed that the incidence of no or slow reflow was less in Shenmai Injection(参麦注射液)group than in the control group measured by thrombolysis in myocardial infarction(TIMI)2(risk ratio=0.55,95%confidence interval 0.38 to 0.81,P=0.003,I^2=37%).Two studies indicated that Salvianolate Injection showed no additional benefit on no or slow reflow measured by corrected TIMI frame count compared with the conventional treatment(mean difference–4.24,95% confidence interval–13.03 to 4.54,P=0.34,I^2=86%).In addition,Tongxinluo Capsules(通心络胶囊),Danhong Injection(丹红注射液)and Xuesaitong Injection(血塞通注射液)may have the potential to reduce no or slow reflow measured during or after PCI in individual studies.Conclusions:Current evidence from RCTs are not sufficient to evaluate the effect of CM adjuvant therapies on no or slow reflow after PCI for MI patients.The included studies are limited by small sample size and unclear baseline conditions.Further rigorously designed researches and verification studies with sufficient number of patients are warranted.

Effect of pre-procedural statin therapy on myocardial no-reflow following percutaneous coronary intervention： a meta analysis

Background Successful revascularization of coronary artery disease, especially ST-elevation myocardial infarction （STEMI）, does not always mean optimal myocardial reperfusion in a portion of patients because of no-reflow phenomenon. We hypothesized that statins might attenuate the incidence of myocardial no-reflow when used before percutaneous coronary intervention （PCI）. The purpose of this study was to summarize the evidence of pre-procedural statin therapy to reduce myocardial no-reflow after PCI. Methods We searched the MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to October 2012 for clinical trials that examined statin therapy before PCI. We required that studies initiated statins before PCI and reported myocardial no-reflow. A DerSimonian-Laird model was used to construct random-effects summary risk ratios. Results In all, 7 studies with 3086 patients met our selection criteria. The use of pre-procedural statins significantly reduced post-procedural no-reflow by 4.2% in all PCI patients （risk ratio （RR） 0.56, 95% confidence interval （CI） 0.35 to 0.90, P=0.016）, and attenuated by 5.0% in non-STEMI patients （RR 0.41, 95% CI 0.18 to 0.94, P=0.035）. This benefit was mainly observed in the early or acute intensive statin therapy populations （RR 0.43, 95% CI 0.26 to 0.71, P=0.001）. Conclusions Acute intensive statin therapy before PCI significantly reduces the hazard of post-procedural no-reflow phenomenon. The routine use of statins before PCI should be considered.

Clinical significance of intra-aortic balloon pumping on no-reflow phenomenon of primary percutaneous coronary intervention for acute myocardial infarction

Background Percutaneous coronary intervention （PCI） is used as a treatment for acute myocardial infarction （AMI）, and one of its major complications is the angiographic no-reflow phenomenon （NR）. Although intra-aortic balloon pumping （IABP） is sometimes used in such patients to increase the diastolic coronary blood flow, there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon. Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 and December 2009, of which 12 patients were selected for IABP therapy and the left 10 were selected as the control group by group procedure of odd and even days; We observed the vasoactive substance in both groups on the days of 1, 2, 3, 5, 7, 10 after the different interventions, which include plasma renin activity （PRA）, angiotensin Ⅱ （ANG Ⅱ）, aldosterone （ALD）, adrenaline （E）, and noradrenalin （NE）; In addition, cardiac structure and cardiac ventricle systolic function including left atrium medial diameter （LAMD）, left ventricular medial diameter （LVMD） Finally, left ventricular ejection fraction （LVEF） were evaluated after 10 days, 3 months and 6 months; statistics was taken to analysis. Results According to the time concentration curve, vasoactive substance of the IABP group decreased faster than that of the control group, and this difference had statistical significance （P 〈 0.01 ） ; In terms of LAMD, LVMD, and LVEF, echocardiography difference of the IABP and the control group in 10 days, 3 months, and 6 months also showed statistical significance （P 〈 0.05）. Conclusions IABP can significantly reduce the release of vasoactive substances of NR in patients of primary PCI for AMI; LAMD, LVMD and LVEF in 10 days, 3 months, and 6 months can be improved using this method, which is conducive to recovery of heart function.

急性冠脉综合征患者血清sST2及NLRP3水平与介入术后无复流-慢血流的相关性分析

目的探讨急性冠脉综合征(acute coronary syndrome,Acs)患者血清可溶性生长刺激表达基因蛋白2(soluble growth stimulation expression gene 2 protein,sST2),核苷酸寡聚化结构域样受体热蛋白结构域相关蛋白3(nucleotide oligomerization domain like receptor heat protein domain associated protein 3,NLRP3)水平与经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后无复流-慢血流的关系。方法选择2020年1月~2022年12月佳木斯市中心医院收治的97例急性冠脉综合征患者,所有患者均接受PCI治疗,根据术后无复流-慢血流发生情况分为无复流-慢血流组(n=20)和对照组(n=77)。术前检测血清sST2及NLRP3水平,分析影响急性冠脉综合征患者PCI术后无复流-慢血流的因素以及sST2,NLRP3预测急性冠脉综合征患者PCI术后无复流-慢血流的价值。结果无复流-慢血流组血清sST2(14.32±2.65 ng/ml vs 11.02±2.13 ng/ml),NLRP3(68.23±10.17 pg/ml vs 42.05±8.23 pg/ml)水平高于对照组,差异具有统计学意义(t=5.860,12.055,均P<0.05)。多因素Logistic回归分析显示高血栓负荷(OR:7.791,95%CI:2.834~21.421)、高水平sST2(OR=2.071,95%CI:1.146~3.743)、高水平NLRP3(OR=2.008,95%CI:1.228~3.284)是急性冠脉综合征患者PCI术后无复流-慢血流的危险因素(均P<0.05)。sST2,NLRP3诊断急性冠脉综合征患者PCI术后无复流-慢血流的临界值分别为12.91ng/ml,55.39 pg/ml,曲线下面积分别为0.737,0.686,联合sST2,NLRP3诊断急性冠脉综合征患者PCI术后无复流-慢血流的曲线下面积为0.907,高于单独诊断(Z=2.662,2.856,均P<0.05)。结论急性冠脉综合征患者血清sST2,NLRP3水平增高与PCI术后无复流-慢血流的发生有关,联合检测sST2和NLRP3可提高对术后无复流-慢血流的诊断效能。

Effect of intracoronary administration of anisodamine on slow reflow phenomenon following primary percutaneous coronary intervention in patients with acute myocardial infarction

Background Many basic and clinical studies have proved that anisodamine can produce significant effect on relieving microvascular spasm, improving and dredging the coronary microcirculation. It may be beneficial to the improvement of slow-reflow phenomenon （SRP） following percutaneous coronary intervention （PCI） for acute myocardial infarction （AMI）. So we investigated the effect of intracoronary administration of anisodamine on SRP of infarct related artery （IRA） following primary PCI in patients with ST segment elevated acute myocardial infarction （STEAMI）. Methods Twenty-one patients with SRP from a total of 148 STEAMI patients accepted primary PCI were enrolled into this study from September 2004 to December 2005. When SRP happened, nitroglycerin （200 μg） was ＂bolus＂ injected firstly into IRA to exclude the spasm of epicardial artery and identify SRP as well as a baseline and self-control agent following PCI. Ten minutes later, 1000 μg of anisodamine was injected into IRA with SRP at 200 μg/s, while the coronary angiography （CAG） was taken before and at 1st, 3rd and 10th minute after administration of nitroglycerin or anisodamine, respectively. The corrected TIMI frame count （cTFC）, TIMI myocardial perfusion grade （TMPG） and the diameter of IRA were calculated and analyzed by Gibson＇s TIMI frame count method using quantitative computer angiography （QCA） system to evaluate the influence of anisodamine on coronary flow and vessel lumen. In the meantime the invasive hemodynamic parameters of intracoronary and systemic artery （systolic, diastolic and mean pressure） and electrocardiogram （ECG） were measured and monitored. The changes of ventricular performance parameters and the adverse reaction were evaluated and followed-up at 1 month post-PCI. Results No significant changes in cTFCs and TMPGs were found at 1st, 3rd and 10th minute after intracoronary administration of nitroglycerin as compared with the baseline control （P〉0.05）. cTFCs were decreased by 58.3%, 56.2% and 54.6%, respectively （P〈0.001）, and TMPGs were increased from 1.13±0.21 grade to 2.03±0.32, 2.65±0.45 and 2.51±0.57 grades （P〈0.05） at 1st, 3rd and 10th minute after intracoronary administration of anisodamine as compared with those after intracoronary administration of nitroglycerine, respectively. The average coronary blood flow of TIMI grade was improved from 1.76±0.43 to 2.71±0.46 （P〈0.05） while the diameter of middle segment in re-patented coronary artery was slightly increased from （3.20±0.40） mm to （3.40±0.50） mm at the 3rd minute after intracoronary administration of anisodamine （P〉0.05） as compared with those of nitroglycerine control. The systolic, diastolic and mean pressures of intracoronary artery after intracoronary administration of anisodamine increased from 115 to 123, 75 to 84, 88 to 95 mmHg （P〈0.05）, respectively, along with the rise of heart rate from 68 to 84 beats per minute （P〈0.05）. There were no significant changes in intervals of PR, QT and QRS （P〉0.05） and no any severe fast arrhythmia after intracoronary administration of anisodamine. The ventricular performance parameters were significantly improved and no major adverse cardiovascular events （MACE） were found during follow-up at 1 month post-PCI. Conclusions Intracoronary administration of 1000 μg anisodamine is effictive in reversing SRP following PCI in STEAMI patients, especially it is suitable for SRP patients with bradycardia or hypotension.

Effect of intracoronary sodium nitroprusside and tirofiban injection on myocardial injury in patients with no reflow in PCI

Objective: To study the effect of intracoronary sodium nitroprusside and tirofiban injection on myocardial injury in patients with no reflow in PCI. Methods: Patients with acute coronary syndrome who underwent PCI and had no reflow in Gong'an County People's Hospital in Hubei Province between August 2014 and July 2017 were selected as the research subjects and randomly divided into two groups, combined group accepted intracoronary sodium nitroprusside and tirofiban injection during PCI, and control group accepted intracoronary tirofiban injection during PCI. The serum levels of myocardial injury indexes, oxidative stress indexes and inflammatory mediators of the two groups were measured before treatment and 1 d after treatment. Results: 1 d after treatment, serum CK-MB, H-FABP, sFas, cMyBP-C, MPO, MDA, Caspase-3, MCP-1, IL-1β, IL-18, MMP2 and MMP9 levels of both groups were significantly lower than those before treatment whereas SOD and NQO-1 levels were higher than those before treatment, and serum CK-MB, H-FABP, sFas, cMyBP-C, MPO, MDA, Caspase-3, MCP-1, IL-1β, IL-18, MMP2 and MMP9 levels of combined group were significantly lower than those of control group whereas SOD and NQO-1 levels were higher than those control group. Conclusion: Intracoronary sodium nitroprusside and tirofiban injection can reduce the myocardial injury in patients with no reflow in PCI.

术前cTnI、NT-proBNP及D-二聚体水平对急性冠状动脉综合征患者PCI术中无复流的预测价值

目的探讨术前肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)及D-二聚体水平对急性冠状动脉综合征患者经皮冠状动脉介入治疗(PCI)术中无复流的预测价值。方法选取郑州颐和医院于2021年1月至2023年1月收治的急性冠状动脉综合征患者120例,均在发病12 h内给予PCI,根据术中心肌梗死溶栓治疗血流情况将其分为正常血流组(98例)及无复流组(22例),比较两组患者术前血清cTnI、NT-proBNP及D-二聚体水平,临床资料,多因素分析影响患者PCI术中无复流的影响因素,绘制受试者工作曲线(ROC)分析术前血清cTnI、NT-proBNP及D-二聚体水平对PCI术中无复流的预测价值。结果无复流组术前血清cTnI、NT-proBNP及D-二聚体水平均高于正常血流组(P<0.05);无复流组年龄高于正常血流组(P<0.05),高血压患者多于正常血流组(P<0.05);回归结果显示,血清cTnI、NT-proBNP及D-二聚体高水平均是急性冠状动脉综合征患者在PCI术中发生无复流的危险因素(P<0.05);ROC结果显示,cTnI(AUC=0.873,95%CI:0.791~0.956,P<0.001)、NT-proBNP(AUC=0.921,95%CI:0.864~0.978,P<0.001)及D-二聚体(AUC=0.827,95%CI:0.727~0.927,P<0.001)对急性冠状动脉综合征患者PCI术中发生无复流诊断价值较高。结论急性冠状动脉综合征患者术前cTnI、NT-proBNP及D-二聚体高水平是患者PCI术中发生无复流的危险因素,三者对术中发生无复流均具有一定预测价值,NT-proBNP预测价值相对较高。

血清SDC-1、THBS-1水平与急性STEMI患者PCI术后无复流发生的相关性

目的探究血清多配体蛋白聚糖-1(SDC-1)、血小板反应蛋白1(THBS-1)水平与急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后无复流发生的相关性。方法纳入2020年1月—2023年12月江苏省昆山市第一人民医院心血管内科诊治急性STEMI患者394例为病例组,根据PCI术后血液是否复流分为复流亚组(n=308)和无复流亚组(n=86),另纳入体检健康人群402例为健康对照组。采用酶联免疫吸附法(ELISA)测定血清SDC-1、THBS-1表达水平;采用Pearson/Spearman法分析血清SDC-1、THBS-1表达与发生无复流患者临床资料的相关性;Logistic回归分析PCI术后无复流发生的影响因素;绘制受试者工作特征曲线(ROC)分析血清SDC-1、THBS-1水平预测急性STEMI患者PCI术后无复流发生的价值。结果与健康对照组比较,病例组血清SDC-1、THBS-1水平升高(t/P=170.052/<0.001、62.118/<0.001)。与复流亚组比较,无复流亚组患者冠状动脉病变长、冠状动脉病变支数多(t/χ^(2)/P=9.035/<0.001、11.443/0.001),无复流亚组血清SDC-1、THBS-1水平均升高(t/P=8.885/<0.001、8.754/<0.001);急性STEMI经PCI术后无复流患者血清SDC-1、THBS-1与冠状动脉病变长度、冠状动脉多支病变均呈正相关(SDC-1:r/r s/P=0.412/<0.001、0.539/<0.001;THBS-1:r/r s/P=0.457/<0.001、0.582/<0.001);急性STEMI患者冠状动脉病变长、冠状动脉多支病变及血清SDC-1高、THBS-1高均为PCI术后无复流发生的危险因素[OR(95%CI)=3.363(1.450~7.794)、3.625(1.783~7.370)、4.391(2.722~7.084)、5.146(3.695~7.167),P均<0.001];血清SDC-1、THBS-1及二者联合预测急性STEMI患者PCI术后无复流发生的AUC分别为0.812、0.770、0.882,二者联合优于各自单独预测效能(Z/P=2.046/0.041、3.274/0.001)。结论PCI术后发生无复流的急性STEMI患者血清SDC-1、THBS-1水平均升高,是无复流发生的危险因素,二者联合具有较高的预测价值。

C-ACS风险评分对STEMI患者PCI术后无复流或慢血流的预测价值

目的评估加拿大急性冠状动脉综合征(Canada Acute Coronary Syndrome,C-ACS)风险评分对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后无复流或慢血流的预测价值。方法纳入2022年1月至2023年4月就诊于陕西省核工业二一五医院接受PCI的STEMI患者共计121例,其中男87例,女34例,平均年龄67.4岁。依照是否合并无复流/慢血流进行分组,对比两组患者临床资料。采用logistic回归分析寻找STEMI患者PCI术后无复流或慢血流的影响因素。使用受试者操作特征曲线(ROC)评估C-ACS风险评分对STEMI患者PCI术后无复流或慢血流的预测价值。采用独立样本t检验、χ^(2)检验。结果无复流/慢血流组患者年龄、男性占比、吸烟率、血肌酐水平以及全球急性冠状动脉事件注册(Global Registry of Acute Coronary Events,GRACE)评分、C-ACS风险评分均明显高于正常血流组,差异均有统计学意义(均P<0.05)。年龄增长、GRACE评分升高、C-ACS风险评分升高、男性、吸烟均为影响STEMI患者PCI术后无复流或慢血流的危险因素(均P<0.05)。C-ACS风险评分预测STEMI患者PCI术后无复流或慢血流的灵敏度为72.9%,特异度为75.3%,曲线下面积(AUC)为0.783;C-ACS风险评分联合GRACE评分预测STEMI患者PCI术后无复流或慢血流的灵敏度为70.8%,特异度为86.3%,AUC为0.844;C-ACS风险评分联合GRACE评分预测STEMI患者PCI术后无复流或慢血流的特异度和AUC高于单一指标。结论C-ACS风险评分对STEMI患者PCI术后无复流或慢血流具有较高的预测价值。C-ACS风险评分联合GRACE评分预测STEMI患者PCI术后无复流或慢血流具有更高的特异度。

Intensive cholesterol lowering with statin improves the outcomes of percutaneous coronary intervention in patients with acute coronary syndrome

Background The incidence of no reflow phenomenon limits the clinical outcomes of percutaneous coronary intervention （PCI）. This randomized controlled study was designed to evaluate the immediate protective effects of intensive statin pretreatment on myocardial perfusion and myocardial ischemic injury during PCI.Methods Altogether 228 patients with acute coronary syndrome （ACS） were randomly assigned to standard statin group （SS group, n=115） and intensive statin group （IS group, n=-113）. Patients in the SS group received 20 mg simvastatin and patients in the IS group received 80 mg simvastatin for 7 days before PCI. Thrombolysis in myocardial infarction （TIMI） flow grade （TFG）, corrected TIMI frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） of the intervened vessel were recorded before and after stent deployment. Creatine kinase （CK） isoenzyme MB, troponin I and plasma level of high sensitive-C reactive protein （hs-CRP）, P-selectin and intercellular adhesion molecule （ICAM） were measured before and 24 hours after the procedure.Results The TFG after stent deployment was significantly improved with less TIMI 0-1 and more TIMI 3 blood flow in the IS group than in the SS group （all P〈0.05）. Patients with no reflow phenomenon were less in the IS group （P〈0.001）. The CTFC was lower in the IS group than in the SS group （P 〈0.001）. TMPG was also improved in the IS group than in the SS group （P=0.001）. Although PCI caused a significant increase in CK-MB 24 hours after the procedure, the elevated CK-MB value was lower in the IS group than in the SS group （18.74±8.41 vs 21.78±10.64, P=0.018）. Similar changes were also found in troponin I （0.99±1.07 in the IS group vs 1.47±1.54 in the SS group, P=0.006）. CK-MB elevation occurred in 27.8% （32/115） of the patients in the SS group vs 15.9% （18/113） in the IS group （P=-0.030）. Myocardial necrosis was detected in 4.4% （5/115） of the patients in the SS group, whereas 0.9% （1/113） in the IS group （P=0.341）. But no myocardial infarction was found. Similarly, the patients with increased level of troponin I were much more in the SS group （36.5%, 42/115） than in the IS group （19.5%, 22/113） （P=0.04）. Among them, myocardial necrosis was detected in 13.0% （15/115） of the patients in the SS group, while 4.4% （5/113） in the IS group （P=-0.021）. Myocardial infarction was found in 4.4% （5/115） of the patients in the SS group and 0.9% （1/113） in the IS group （P=0.213）.Conclusions Intensive statin pretreatment for 7 days before PCI can further improve myocardial blood perfusion, protect the myocardium from ischemic injury. These effects are associated with the lowered levels of hs-CRP, P-selectin and ICAM.

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

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。

替罗非班对冠脉无复流患者内皮微粒和可溶性细胞间黏附分子-1的影响

目的:评价替罗非班对冠状动脉介入治疗(PCI)后无复流患者循环血中内皮微粒(EMPs)和可溶性细胞间黏附分子-1(sICAM-1)的影响。方法:将行PCI治疗后发生无复流的急性冠脉综合征(ACS)患者52例分为替罗非班组(n=26)和硝酸甘油组(n=26),以32例未发生无复流的患者作为对照组。于PCI前、PCI后即刻和PCI后48h采集静脉血,采用流式细胞术测定患者血浆EMPs水平,酶联免疫法测定血清sICAM-1水平。结果:发生无复流患者循环血中EMPs和sICAM-1水平高于对照组(均P<0.05);在治疗后48h,替罗非班组EMPs和sICAM-1水平均明显低于硝酸甘油组,差异有统计学意义(均P<0.05)。EMPs和sICAM-1水平呈显著正相关(rs=0.654,P=0.004)。结论:替罗非班可明显降低PCI后无复流患者EMPs和sICAM-1水平,改善无复流。EMPs对反映PCI后无复流患者冠脉内皮细胞炎症反应和损伤程度有一定的临床意义。

急性冠状动脉综合征患者PCI术前血清ICAM-1、ESM-1水平与术后冠状动脉慢血流/无复流的相关性

目的探讨急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)术前血清细胞间黏附分子-1(ICAM-1)、内皮细胞特异性分子-1(ESM-1)水平与PCI术后冠状动脉慢血流/无复流(CSF/CNR)的相关性。方法选择2018年10月—2021年5月华北石油管理局总医院心内科行PCI术的ACS患者354例为研究组,根据患者PCI术后是否发生CSF/CNR,将患者分为正常血流(NCF)亚组291例和CSF/CNR亚组63例,同期选取在医院体检健康者360例为健康对照组。检测并比较健康对照组和研究组、NCF亚组和CSF/CNR亚组、研究组不同疾病类型PCI术前血清ICAM-1、ESM-1水平,Pearson法分析CSF/CNR亚组PCI术前血清ICAM-1与ESM-1的相关性,Logistic回归分析影响ACS患者PCI术后发生CSF/CNR的危险因素,受试者工作特征曲线分析PCI术前血清ICAM-1、ESM-1水平对ACS患者PCI术后发生CSF/CNR的预测价值。结果与健康对照组比较,研究组PCI术前血清ICAM-1、ESM-1水平显著升高(t/P=104.562/<0.001、52.608/<0.001);与NCF亚组比较,CSF/CNR亚组PCI术前血清ICAM-1、ESM-1水平显著升高(t/P=19.878/<0.001、21.652/<0.001);研究组中急性ST段抬高型心肌梗死(STEMI)、急性非ST段抬高型心肌梗死(NSTEMI)、不稳定型心绞痛(UAP)患者PCI术前血清ICAM-1、ESM-1水平比较差异无统计学意义(P>0.05);CSF/CNR亚组患者PCI术前血清ICAM-1与ESM-1水平呈正相关(r/P=0.484/<0.001);PCI术前血清ICAM-1、ESM-1高水平是ACS患者PCI术后发生CSF/CNR的危险因素[OR(95%CI)=3.104(1.536~6.273),3.267(1.741~6.129)];PCI术前血清ICAM-1、ESM-1水平预测ACS患者PCI术后发生CSF/CNR的曲线下面积(AUC)分别为0.744、0.775,二者联合为0.883,优于各自单独检测(Z/P=3.129/0.002、2.798/0.001)。结论ACS患者PCI术前血清ICAM-1、ESM-1水平呈高表达,二者与ACS患者PCI术后发生CSF/CNR有关,可能是临床上预测ACS患者PCI术后发生CSF/CNR的潜在生物标志物。

急性心肌梗死经皮冠脉介入术后无复流现象及654-2的干预

目的评价冠状动脉内应用654-2对急性心肌梗死(AMI)经皮冠状动脉腔内成形术(PCI)后无复流现象的疗效及其安全性。方法21例AMI直接PCI后梗死相关动脉(IRA)存在无复流患者,男14例,女7例,年龄62.3±9.3岁。从症状开始至PCI术开通IRA时间7.14±2.32 h,术后平均TIMI血流1.76±0.43级,以硝酸甘油200μg冠状动脉内注入,10 min后以654-2 500μg冠状动脉内注入,于给药后第1、3、10分钟行冠状动脉造影(CAG)。应用TIMI血流计帧法和QCA分别测定硝酸甘油和654-2冠状动脉内给药后不同时间点的IRA血流速率帧数和管腔直径。结果①术后基础对照与硝酸甘油给药第1、3分钟时CAG血流帧数变化比较差异无显著性(83.80±9.40 vs 78.33±10.39帧、83.80±9.40 vs 77.47±10.51帧,P均>0.05);654-2给药后第1、3和10分钟时CAG血流帧数分别较给药前减少58.3%、56.2%和54.6%(P均<0.001);②冠状动脉内给予654-2后3 min时IRA管径亦较前略有增加(3.20±0.26 mm vs 3.30±0.25 mm,P>0.05);③654-2冠状动脉内给药后10 min内连续监测冠状动脉内压、外周血压、PR间期、QT间期和QRS时限各参数,与给药前比较差异均无显著性(P>0.05)。结论冠状动脉内应用654-2 500μg可改善AMI直接PCI术后无复流现象,且安全易行,可作为治疗IRA开通后无复流现象的有效药物之一。

大剂量氯吡格雷对急诊PCI患者再灌注及hs-CRP的影响

目的探讨不同剂量氯吡格雷对急性心肌梗死(acute myocardial infarction,AMI)患者急诊行PCI术后再灌注及hs-CRP水平的影响。方法以121例住院行急诊PCI的AMI患者为研究对象,根据氯吡格雷首剂用量随机分为300 mg负荷量组(对照组)和600 mg负荷量组(观察组)。观察两组患者PCI术中无复流的发生情况及术前、术后24 h hs-CRP水平的变化。结果观察组术中无复流的发生率明显低于对照组(P<0.05);术后24 h观察组hs-CRP水平低于对照组(P<0.05)。结论对于急性心肌梗死急诊PCI患者,术前首次给予负荷剂量600 mg的氯吡格雷能够预防PCI术中无复流的发生及减少炎症反应。

急性心肌梗死患者血清miR-133a、miR-499-5p表达与PCI术后冠状动脉无复流的关系

目的探讨急性心肌梗死(AMI)患者血清微小核糖核酸(miR)-133a、miR-499-5p表达及其与AMI患者经皮冠状动脉介入(PCI)术后冠状动脉无复流的关系。方法选取2019年2月至2021年10月该院收治的290例接受PCI治疗的AMI患者作为研究对象。依据PCI术后3个月患者冠状动脉血流情况分为无复流组[心肌梗死溶栓治疗(TIMI)分级1~2级]、复流正常组(TIMI 3级)。分析术前血清miR-133a、miR-499-5p表达与AMI患者PCI术后无复流的关系。结果随访3个月后,290例AMI患者PCI术后TIMI分级1~2级66例,3级224例;冠状动脉无复流发生率为22.76%(66/290)。无复流组发病至PCI时间长于复流正常组,术前白细胞计数(WBC)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、miR-133a、miR-499-5p表达水平高于复流正常组,差异均有统计学意义(P<0.05).Logistic回归分析结果显示,发病至PCI时间长,以及术前WBC、CK-MB、cTnI、miR-133a、miR-499-5p高是AMI患者PCI术后血流TIMI分级低的危险因素(OR>1,P<0.05);受试者工作特征(ROC)曲线分析结果显示,术前血清miR-133a、miR-499-5p及二者联合预测AMI患者PCI术后冠状动脉无复流的曲线下面积(AUC)为0.727、0.697、0.773,具有一定的预测价值;决策曲线分析结果显示,在高风险阈值0.00~1.00范围内血清miR-133a、miR-499-5p联合预测AMI患者PCI术后冠状动脉无复流的净收益率>0,有临床意义。结论AMI患者PCI术前血清miR-133a、miR-499-5p水平与术后冠状动脉无复流有关。

经皮冠状动脉介入治疗急性心肌梗死术中发生慢血流-无复流分析

目的探讨在经皮冠状动脉介入(PCI)治疗急性心肌梗死术中发生慢血流-无复流(SCF/NR)的相关影响因素,为防治术中发生慢血流-无复流做指导。方法选择2014年1月—2016年6月因急性心肌梗死在云南省第二人民医院心内科住院行PCI治疗发生慢血流-无复流病例61例,男52例,女9例。收集的内容主要有性别、年龄、体质指数、吸烟、饮酒、高血压病、糖尿病、总胆固醇、三酰甘油、尿酸、肌酐、心肌梗死诊断分型、心功能分级、犯罪血管、瘤样扩张血管、术中及术后血流分级(TIMI)、给药方式及给予药物、冠脉造影结果、发病-球囊时间等。研究术中导致慢血流-无复流的因素有哪些,并应用统计学软件筛选导致慢血流-无复流现象的预测因素。结果使用Logistic回归分析慢血流-无复流的危险因素:年龄、吸烟、体质指数、糖尿病、冠脉血管瘤样扩张、三酰甘油、总胆固醇、发病-球囊时间、给药方式及给予药物与术中发生慢血流-无复流的危险因素关系密切(P<0.05);性别、高血压、饮酒、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、尿酸、肌酐、谷草转氨酶、谷丙转氨酶水平、心肌梗死诊断分型、心功能分级、犯罪血管与术中发生慢血流-无复流形成的危险因素无关系(P>0.05)。结论年龄、吸烟、体质指数、糖尿病、冠脉血管瘤样扩张、三酰甘油、总胆固醇、发病-球囊时间、给药方式及给予药物能够单独地导致术中出现慢血流-无复流组的独立危险因素,提前发现影响患者手术后疗效的相关因素,对于提升预后效果来说很有帮助。