D-二聚体联合CHA2DS2-VASc评分对老年急性心肌梗死患者介入术后无复流的预测价值

目的探讨血浆D-二聚体水平联合CHA2DS2-VASc评分对老年急性ST段抬高型心肌梗死(STEMI)患者PCI术后无复流的预测价值。方法选择2018年1月~2019年8月大连市友谊医院心内科接受直接PCI的老年STEMI患者117例,根据TIMI血流和心肌呈色分级分为复流组92例,无复流组25例。又根据D-二聚体水平分为高D-二聚体组75例(D-二聚体>1.01 mg/L),低D-二聚体组42例(D-二聚体≤1.01 mg/L)。比较复流组和无复流组血浆D-二聚体水平及CHA2DS2-VASc评分,分析两者对无复流现象的预测价值。结果无复流组D-二聚体及CHA2DS2-VASc评分明显高于复流组(1.72 mg/L vs 0.48 mg/L,P=0.001;4.00分vs 3.00分,P=0.002)。ROC曲线分析显示,D-二聚体联合CHA2DS2-VASc评分预测无复流的曲线下面积为0.777(95%CI:0.683~0.870,P=0.001),较两者单独预测无复流效果更好。高D-二聚体组血栓抽吸和无复流比例明显高于低D-二聚体组,差异有统计学意义(P<0.05,P<0.01)。多元logistic回归分析显示,血浆D-二聚体及CHA2DS2-VASc评分是无复流的独立预测因素(P<0.05,P<0.01)。结论血浆D-二聚体水平联合CHA2DS2-VASc评分预测无复流现象较单用D-二聚体水平或CHA2DS2-VASc评分更敏感。

Value of serum D-dimer level combined with CHA2DS2-VASc score in predicting no reflow in elderly acute STEMI patients after PCI

Objective To study the value of serum D-dimer level combined with CHA2DS2-VASc score in predicting no reflow in elderly acute ST-segment elevation myocardiol infarction(STEMI)patients after PCI.Methods One hundred and seventeen elderly STEMI patients who underwent PCI in our hospital from January 2018 to August 2019 were divided into reflow group(n=92)and no reflow group(n=25)according to their TIMI blood flow and myocardial color grading or divided into serum D-dimer level>1.01 mg/L group(n=75)and serum D-dimer level≤1.01 mg/L group(n=42).The serum D-dimer level and CHA2DS2-VASc score were compared between reflow group and no reflow group.The value of serum D-dimer level and CHA2DS2-VASc score in predicting no reflow in elderly acute STEMI patients after PCI was analyzed.Results The serum D-dimer level and CHA2DS2-VASc score were significantly higher in no reflow group than in reflow group(1.72 mg/L vs 0.48 mg/L,P=0.001;4.00 vs 3.00,P=0.002).ROC curve analysis showed that the area under the ROC curve for serum D-dimer level combined with CHA2DS2-VASc score in predicting no reflow was 0.777(95%CI:0.683-0.870,P=0.001),which was better than that for serum D-dimer level or CHA2DS2-VASc score alone in predicting no reflow.The ratio of thrombus aspiration and no reflow was significantly higher in serum D-dimer level>1.01 mg/L group than in serum D-dimer level≤1.01 mg/L group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that serum D-dimer level and CHA2DS2-VASc score were the independent predictors for no reflow in elderly acute STEMI patients after PCI(P<0.05,P<0.01).Conclusion Serum D-dimer level combined with CHA2DS2-VASc score is more effective than serum D-dimer level or CHA2DS2-VASc score alone in predicting no reflow in elderly acute STEMI patients after PCI.