急性心肌梗死急诊经皮冠状动脉介入术后慢血流/无复流的相关因素研究

Study on related factors of slow blood flow or no reflow after emergency PCI for acute myocardial infarction

摘要:

目的 分析急性心肌梗死（AMI）患者急诊经皮冠状动脉介入术（PCI）后慢血流/无复流的相关因素。方法 回顾性分析2018年5月—2020年9月于沧州市中心医院接受急诊PCI术的280例AMI患者的临床资料，根据术后是否出现慢血流/无复流分为慢血流/无复流组（46例）和正常血流组（234例）。比较两组的基线资料、造影结果、手术相关指标、生化指标、住院期间用药情况；采用多因素Logistic回归分析影响PCI术后慢血流/无复流发生的危险因素。结果 两组的收缩压、吸烟、症状至PCI时间及Killip分级，差异有统计学意义（P <0.05）；两组的性别构成、年龄、舒张压、心率、高血压、糖尿病、高脂血症、心肌梗死部位比较，差异无统计学意义（P >0.05）。两组的血栓负荷程度比较，差异有统计学意义（P <0.05）；两组的血管直径、入院至球囊扩张时间、支架数量、球囊扩张次数、病变血管数量、梗死相关血管、病变位置比较，差异无统计学意义（P >0.05）。两组入院即刻血糖、D-D、LDL-C水平比较，差异有统计学意义（P <0.05），慢血流/无复流组入院即刻血糖、D-D、LDL-C水平高于正常血流组；两组Scr、UA、TC、TG、HDL-C、WBC、NEU、ALT、AST、GGT比较，差异无统计学意义（P >0.05）。两组住院期间用药情况比较，差异无统计学意义（P >0.05）；多因素Logistic回归分析结果显示：吸烟［O^R =2.197 （95%CI：1.158，4.167）］、收缩压 <120 mmHg［O^R =1.889（95%CI：1.564，2.672）］、症状至PCI时间 ≥6 h［O^R =3.094（95%CI：1.618，5.914）］、Killip分级 ≥Ⅱ级［O^R =2.014 （95%CI：1.016，3.989）］、入院即刻血糖 ≥10.0 mmol/L［O^R =1.546（95%CI：1.168，2.465）］、D-D ≥0.5 mg/L［O^R =1.956 （95%CI：1.175，2.745）］、LDL-C ≥3.37 mmol/L［O^R =1.624（95%CI：0.895，2.165）］、重度血栓负荷［O^R =2.369 （95%CI：1.325，5.750）］均是PCI术后慢血流/无复流发生的危险因素（P <0.05）。结论 吸烟、收缩压、症状至PCI时间、Killip分级、入院即刻血糖、D-D、LDL-C及血栓负荷程度是AMI患者PCI术后慢血流/无复流发生的危险因素，临床应规避上述风险因素，密切监测围手术期入院即刻血糖、D-D、LDL-C水平变化，以降低术后慢血流/无复流发生风险。

Abstract:

Objective TTo analyze the related factors of slow blood flow or no reflow after emergency percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI).Methods The clinical data of 280 AMI patients who underwent emergency PCI in Cangzhou Central Hospital from May 2018 to September 2020 were analyzed retrospectively. According to whether there was slow blood flow / no reflow after operation, they were divided into slow blood flow no reflow group (46 cases) and normal blood flow group (234 cases). The baseline data, angiographic results, operation related indexes, biochemical indexes, and medication during hospitalization were compared between the two groups. A logistic regression model was established to analyze the risk factors of slow blood flow / no reflow after PCI.Results There were significant differences in systolic blood pressure, smoking, time from symptoms to PCI and Killip grade between the two groups (P < 0.05). There was significant difference in the degree of thrombus load between the two groups (P < 0.05). There was no significant difference in vessel diameter, time from admission to balloon dilatation, number of stents, times of balloon dilatation, number of diseased vessels, infarct related vessels, and lesion location between the two groups (P > 0.05). There was no difference in the ratio of sex composition, age, diastolic blood pressure, heart rate, prevalence of hypertension, diabetes prevalence, hyperlipidemia prevalence, and composition of the site of myocardial infarction between two groups (P > 0.05).There were significant differences in immediate blood glucose, D-D, and LDL-C levels between two groups (P < 0.05), and the levels of blood glucose, D-D and LDL-C in the slow flow / no reflow group were higher than those in the normal flow group. There was no significant difference in SCR, UA, TC, TG, HDL-C, WBC, NEU, ALT, AST, and GGT between the two groups (P > 0.05). There was no significant difference between the two groups (P > 0.05). Multivariate logistic regression analysis showed that smoking [O^R =2.197 (95% CI: 1.158, 4.167) ], systolic blood pressure < 120 mmHg [O^R =1.889 (95% CI: 1.564, 2.672)], time from symptom to PCI ≥ 6 h [O^R =3.094 (95% CI: 1.618, 5.914) ], Killip grade ≥ grade Ⅱ [O^R =2.014 (95% CI: 1.016, 3.989) ], blood glucose ≥ 10.0 mmol/L [O^R =1.546 (95% CI: 1.168, 2.465) ], D-D ≥ 0.5 mg/L [O^R =1.956 (95% CI: 1.175, 2.745) ], LDL-C ≥ 3.37 mmol/L [O^R =1.624 (95% CI: 0.895, 2.165) ], severe thrombotic load [O^R =2.369 (95% CI: 1.325, 5.750) ] were risk factors for slow blood flow / no reflow after PCI (P < 0.05).Conclusion Smoking, systolic blood pressure, time from symptoms to PCI, Killip grade, blood glucose immediately after admission, D-D, LDL-C, and thrombus load are the risk factors of slow blood flow / no reflow after PCI in patients with AMI. The above risk factors should be avoided and the changes of blood glucose, D-D, and LDL-C levels immediately after admission during perioperative period should be closely monitored to reduce the risk of slow blood flow / no reflow after PCI.