急诊经皮冠状动脉介入治疗冠状动脉造影无复流的相关因素

目的　探讨急诊经皮冠状动脉介入治疗 (percutaneouscoronaryinterventions,PCI)冠状动脉(冠脉 )造影无复流现象的相关因素。方法　自 1999年 1月至 2 0 0 2年 10月 ,回顾性分析 4 97例急诊PCI病人的临床和冠脉造影资料 ,冠脉造影无复流病人 5 8例 ,由其余的 4 39例急诊PCI冠脉前向血流TIMI 3级的病人中随机抽取 6 0例 ,为正常血流组。运用Logistic回归分析无复流的相关因素。结果　无复流的发生率为 12 6 %。单因素分析表明 :糖尿病、症状开始到再灌注的时间、梗死前心绞痛、Kil lip心功能分级、Q波计数、室壁运动积分差异有显著性。而多因素Logistic回归分析表明 :症状开始到再灌注的时间、梗死前心绞痛、Killip心功能分级、Q波计数是无复流的相关因素。结论　大面积心肌坏死、严重的心肌损害、心功能不全和症状开始到再灌注的时间长 ,可能会促使无复流的形成 ;梗死前心绞痛可能减少无复流的发生。而冠心病的危险因素与无复流没有相关性。

Relative factors for angiographic no-reflow phenomenon after primary percutaneous coronary intervention with acute myocardial infarction

Objective To elucidate the relative factors for angiographic no reflow phenomenon after primary percutaneous coronary intervention (PCI) with acute myocardial infarction (AMI) Methods Cilnical and angiographic data of 497 patients after primary PCI were retrospectively analysed between January 1999 and October 2002, fifty eight patients were with angiographic no reflow phenomenon, and 60 patients as normal flow group randomized from 439 with coronary antergrade flow TIMI 3 class after primary PCI were studied Multiple logistic regression analysis was used to identify independent relative factors of the no reflow phenomenon Results Incidence of the no reflow phenomenon was 12 6% Univariate analysis showed that diabetes mellitus, the time from symptom onset to reflow, pre infarction agina, Killip class, number of Q waves on electrocardiogam and wall motion score were related to the no reflow phenomenon However, multiple Logistic regression analysis indicated that the time from symptom onset to reflow, the pre infarction again, Killip class, the number of Q waves on electrocardiogam were the relative factors of the no reflow phenomenon Conclusion Large area of myocardial necrosis, and the severely myocardial damage, and the long time from the symptom onset to reflow can promote the angiographic no reflow phenomenon Pre infarction angina seems to be the factor that attenuates the angiographic no reflow phenomenon However, risk factors of coronary heart disease have no relation to no reflow phenomenon