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女性患者急诊冠状动脉介入后无复流的独立预测因素
引用本文:王长华,陈韵岱,杨新春,王乐丰,王红石,孙志军,刘宏斌,陈练.女性患者急诊冠状动脉介入后无复流的独立预测因素[J].首都医学院学报,2012,33(4):432-436.
作者姓名:王长华  陈韵岱  杨新春  王乐丰  王红石  孙志军  刘宏斌  陈练
作者单位:1. 首都医科大学附属北京安贞医院心内科, 北京 100029;2. 解放军总医院心内科, 北京 100853;3. 首都医科大学附属北京朝阳医院心内科, 北京 100029
摘    要:目的在现代介入治疗时代评价女性急性ST段抬高型心肌梗死(ST-segment elevation acute myocardial infarction,STEMI)患者行急诊经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)后无复流的独立预测因素。方法入选320例STEMI并成功行PPCI的女性患者,分为无复流组和复流正常组。结果女性STEMI患者行PPCI后无复流发生率为25.3%(81/320)。经单变量和多元Logistic回归分析,发现入院收缩压<100 mmHg(1 mmHg=0.133 kPa)(OR=1.991,95%CI:1.018~3.896;P=0.004)、靶病变长度>20 mm(OR=1.948,95%CI:1.908~1.990;P=0.016)、侧支循环0~1级(OR=1.952,95%CI:1.914~1.992;P=0.019)、PPCI前血栓负荷评分≥4(OR=4.184,95%CI:1.482~11.813;P=0.007)和PPCI前主动脉内气囊反搏(intra-aortic balloon pulsation,IABP)使用(OR=1.949,95%CI:1.168~3.253;P=0.011)是女性STEMI患者PPCI后无复流的独立预测因素。无复流发生率随预测因素增加而显著升高,具有0、1、2、3、4和5个无复流独立预测因素时无复流发生率分别为0%(0/2)、10.8%(9/84)、14.5%(17/117)、37.7%(29/77)、56.7%(17/30)和81.8%(9/11)(P=0.000)。结论女性STEMI患者PPCI后无复流预测模型由5个因素组成:入院收缩压<100 mmHg、靶病变长度>20 mm、侧支循环0~1级、PPCI前血栓负荷评分≥4和PPCI前IABP使用。随着无复流预测因素增多,无复流发生率显著升高。

关 键 词:女性  急性心肌梗死  经皮冠状动脉介入治疗  无复流
收稿时间:2012-05-10

A prediction model for no-reflow in female patients treated with primary percutaneous coronary intervention
WANG Chang-hua,CHEN Yun-dai,YANG Xin-chun,WANG Le-feng,WANG Hong-shi,SUN Zhi-jun,LIU Hong-bin,CHEN Lian.A prediction model for no-reflow in female patients treated with primary percutaneous coronary intervention[J].Journal of Capital University of Medical Sciences,2012,33(4):432-436.
Authors:WANG Chang-hua  CHEN Yun-dai  YANG Xin-chun  WANG Le-feng  WANG Hong-shi  SUN Zhi-jun  LIU Hong-bin  CHEN Lian
Affiliation:1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;2. Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China;3. Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100029, China
Abstract:Objective To identify independent no-reflow predictors during primary percutaneous coronary intervention(PPCI) in female patients with ST-segment elevation acute myocardial infarction(STEMI) after various contemporary interventional strategies, thus to establish a model for predicting no-reflow status. Methods Totally 320 female patients with STEMI successfully treated with PPCI were divided into no-reflow group and normal reflow group. Results The no-reflow status was found in 81(25.3%) of 320 female patients. Univariate and multivariate logistic regression identified that low systolic blood pressure(SBP) on admission(<100 mm Hg, OR=1.991, 95% CI: 1.018~3.896; P=0.004), target lesion length(>20 mm, OR=1.948, 95% CI: 1.908~1.990; P=0.016), collateral circulation(0-1, OR=1.952, 95% CI: 1.914~1.992; P=0.019), pre-PPCI thrombus score(≥4, OR=4.184, 95% CI: 1.482~11.813; P=0.007), and intra-aortic balloon pulsation(IABP) use before PPCI(OR=1.949, 95% CI: 1.168~3.253; P=0.011) were independent no-reflow predictors. The no-reflow incidence rate significantly increased as the numbers of independent predictors increased0%(0/2), 10.8%(9/84), 14.5%(17/117), 37.7%(29/77), 56.7%(17/30), and 81.8%(9/11) in female patients with 0, 1, 2, 3, 4, and 5 independent predictors, respectively; P=0.000]. Conclusion The 5 no-reflow predictor variables were low SBP on admission <100 mm Hg, target lesion length >20 mm, collateral circulation 0-1, pre-PPCI thrombus score ≥4, and IABP use before PPCI in female patients with STEMI and PPCI. The prediction model provides a basis for therapeutic decision making.
Keywords:female  acute myocardial infarction  percutaneous coronary intervention  no-reflow
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