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急性ST段抬高型心肌梗死患者直接经皮冠脉介入治疗术中慢血流/无复流的危险因素分析

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摘要:

目的 探讨急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)术中 慢血流/无复流的危险因素。方法 回顾性纳入郑州市第七人民医院心内科于2017年2月至2018年6月因 STEMI行直接PCI的患者212例,根据PCI术中冠状动脉血流分为血流正常组和慢血流/无复流组,比较两 组患者临床病史、血液生化指标、心脏超声资料及PCI资料,应用二分类logistic回归模型分析STEMI患 者直接PCI术中慢血流/无复流的危险因素,绘制受试者工作特征曲线(ROC)确定预测慢血流/无复流 的最佳截断点。结果 慢血流/无复流组患者共47例(22.2%),与血流正常组相比,慢血流/无复流组 患者糖尿病病史和吸烟史的比例均较高(P均<0.001),全球急性冠状动脉事件注册(GRACE)评分 (P=0.002)、同型半胱氨酸(P<0.001)、纤维蛋白原(P=0.006)、N末端脑钠肽前体(P=0.004)均 较高,肌酐清除率(P=0.008)较低,对比剂用量(P=0.018)较多,手术时间(P<0.001)较长,血栓 抽吸(P=0.008)、单纯经皮冠状动脉腔内成形术(P=0.007)、应用主动脉内球囊反搏(P=0.014)比例 均较高。多因素logistic回归分析结果显示,糖尿病病史(OR=3.676,95%CI:1.893~6.244,P=0.002)、 吸烟史(OR=2.843,95%CI:1.902~5.632,P=0.005)、GRACE评分(OR=3.676,95%CI:1.893~6.244, P=0.002)、同型半胱氨酸(OR=5.133,95%CI:2.314~19.943,P=0.001)和纤维蛋白原(OR=3.684, 95%CI:2.106~14.988,P=0.009)是STEMI患者直接PCI术中慢血流/无复流的独立危险因素。GRACE评 分预测慢血流/无复流的最佳截断点为129.5分(AUC=0.629,敏感度75.0%,特异度45.5%),同型半胱 氨酸的最佳截断点为13.8 μmol/L(AUC=0.823,敏感度77.8%,特异度86.8%),纤维蛋白原的最佳截断 点为2.13 g/L(AUC=0.622,敏感度为75.0%,特异度为47.1%)。结论 糖尿病病史、吸烟史、GRACE评 分、同型半胱氨酸和纤维蛋白原是STEMI患者直接PCI术中慢血流/无复流的危险因素,同型半胱氨酸可 能是预测PCI术中慢血流/无复流的有效指标。

Abstract:

Objective To investigate the risk factors of slow / no reflow in patients with acute ST-segment elevation myocardial infarction (STEMI) during percutaneous coronary intervention (PCI). Methods A total of 212 patients who underwent direct PCI for STEMI from February 2017 to June 2018 in Zhengzhou Seventh People's Hospital were retrospectively included, and were divided into normal blood flow group and slow blood flow group according to coronary blood flow during PCI. In the no-reflow group, the clinical history, blood biochemical parameters, cardiac ultrasound data, and PCI data of the two groups were compared. The two-class logistic regression model was used to analyze the risk factors of slow blood flow/no reflow during direct PCI in STEMI patients. The operating characteristic curve (ROC) was used to determine the optimal truncation point for predicting slow/no reflow. Results There were 47 patients (22.2%) in the slow blood flow/no reflow group. Compared with the normal blood flow group, the proportion of patients with diabetes and smoking history was higher in the slow blood flow / no reflow group (all P<0.001). Global acute coronary event registration (GRACE) score (P=0.002), homocysteine (P<0.001), fibrinogen (P=0.006), N-terminal B-type natriuretic peptide (P=0.004) ) Are higher, creatinine clearance (P=0.008) is lower, contrast agent dosage (P=0.018) is more, operation time (P<0.001) is longer, thrombus aspiration (P=0.008), pure percutaneous coronary The proportion of intra-arterial angioplasty (P=0.007) and intra-aortic balloon counterpulsation (P=0.014) were higher. Multivariate logistic regression analysis results showed a history of diabetes (OR=3.676, 95%CI: 1.893~6.244, P=0.002), smoking history (OR=2.843, 95%CI: 1.902~5.632, P=0.005), GRACE score (OR=3.676, 95%CI: 1.893~6.244, P=0.002), homocysteine (OR=5.133, 95%CI: 2.314~19.943, P=0.001), and fibrinogen (OR=3.684, 95%CI: 2.106~14.988, P=0.009) is an independent risk factor for slow/no reflow during direct PCI in STEMI patients. The GRACE score predicts the best cutoff point for slow blood flow/no reflow as 129.5 points (AUC=0.629, sensitivity 75.0%, specificity 45.5%), and the best cutoff point for homocysteine is 13.8 μmol/L ( AUC=0.823, sensitivity 77.8%, specificity 86.8%), the best cut-off point of fibrinogen is 2.13 g/L (AUC=0.622, sensitivity 75.0%, specificity 47.1%). Conclusions Diabetes history, smoking history, GRACE score, homocysteine and fibrinogen are risk factors for slow / no reflow during direct PCI in STEMI patients. Homocysteine may be a predictor of slow blood during PCI. Effective index of flow / no reflow.

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  • 2008

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