急性ST段抬高型心肌梗死急诊冠状动脉支架置入后慢血流或无复流现象的影响因素

目的研究老年急性ST段抬高型心肌梗死(STEMI)患者急诊PCI后出现冠状动脉慢血流现象(CSFP)的潜在临床预测因素。方法选择接受急诊PCI术的老年STEMI患者419例,根据PCI后TIMI分级分为对照组(3级)347例和实验组(0~2级)72例,收集受试者一般临床资料及血管造影等资料。采用ROC曲线分析CSFP的预测因素。结果实验组术中再灌注损伤、支架总长度、造影剂剂量、支架后扩张、合并心源性休克、D-二聚体水平、住院期间病死率以及LVEF<50%比例明显高于对照组(P<0.05)。支架后扩张、D-二聚体水平、造影剂剂量及合并心源性休克均为CSFP的独立危险因素(P<0.05,P<0.01)。D-二聚体水平、支架后扩张及两者联合检测预测CSFP的ROC曲线下面积分别为0.618(95%CI:0.543~0.693)、0.585(95%CI:0.513~0.657)、0.670(95%CI:0.603~0.738)。高D-二聚体患者CSFP发生率和住院期间病死率明显高于低D-二聚体患者(P<0.01)。结论D-二聚体水平及行支架后扩张为CSFP的独立危险因素,且D-二聚体是CSFP不良预后的可靠标志物。

Influencing factors of coronary slow flow or no reflow phenomena in acute STEMI patients after emergency coronary artery stenting

Objective To study the potential clinical predictors of CSFP in elderly acute STEMI patients after emergency PCI.Methods Four hundred and nineteen elderly acute STEMI patients who underwent emergency PCI were divided into control group(n=347)and experimental group(n=72)according to their TIMI grading.Their general clinical data and angiographic data were recorded.The predictors of CSFP were analyzed by ROC curve analysis.Results The incidence of reperfusion injury,post-stent dilatation,cardiogenic shock,and the in-hospital mortality,ratio of LVEF<50%,serum D-dimer level were significantly higher,the total stent length was significantly longer and the contrast medium dose was significantly greater in experimental group than in control group(P<0.05).The post-stent dilatation,serum D-dimer level,contrast medium dose and cardiogenic shock were the independent risk factors for CSFP in elderly acute STEMI patients after emergency PCI(P<0.05,P<0.01).The area under the ROC curve for serum D-dimer level,post-stent dilatation and serum D-dimer level combined with post-stent dilatation in predicting CSFP was 0.618,0.585 and 0.670 respectively.The incidence of CSFP and the rate of in-hospital deaths were significantly higher in patients with a high serum D-dimer level than in those with a low serum D-dimer level(P<0.01).Conclusion Serum D-dimer level and post-stent dilatation are the independent risk factors for CSFP and serum D-dimer level is a reliable marker of poor CSFP outcome in elderly acute STEMI patients after emergency PCI.