[ST段抬高型心肌梗死患者行直接冠状动脉介入治疗时血清尿酸水平与冠状动脉血流的相关性]

[Correlation of serum uric acid levels with coronary flow in patients with ST-segment elevation myocardial infarction undergoing primary coronary intervention].

作者信息

Wang Jin-wen, Chen Yun-dai, Wang Chang-hua, Zhu Xiao-ling

机构信息

Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2012 Nov 27;92(44):3100-3.

PMID:23328417

Abstract

OBJECTIVE

To explore the association of the uric acid levels and coronary blood flow in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

METHODS

A total of 276 STEMI patients undergoing primary PCI were enrolled and divided into 2 groups based upon the Thrombolysis in Myocardial Infarction (TIMI) flow grade. No-reflow was defined as TIMI Grade 0, 1 and 2 flows. The association of uric acid levels on admission with TIMI flow grade after PCI was assessed by multivariate Logistic regression. Major adverse cardiac events (MACE) were defined as death, non-fatal myocardial infarction and need for repeat percutaneous revascularization or coronary artery bypass grafting.

RESULTS

The uric acid level was significantly higher in the no-reflow group (n = 57) than that of the normal-flow group (n = 219, 372 ± 111 vs 303 ± 102, P < 0.01). In-hospital MACEs were significantly higher in the patients with no reflow (8.8% vs 1.8%, P = 0.016). A uric acid level ≥ 345 mmol/L measured on admission had a 61.2% sensitivity and 77.5% specificity in predicting no-reflow at ROC curve analysis. At multivariate analyses, high plasma uric acid (OR 1.01, 95%CI 1.01 - 1.01, P < 0.01), neutrophil count (OR 1.02, 95%CI 1.00 - 1.06, P < 0.01), admission plasma glucose (OR 1.14, 95%CI 1.08 - 1.21, P < 0.01), time from pain to PCI (OR 1.67, 95%CI 0.46 - 5.97, P = 0.012), pre PCI thrombus score ≥ 4 (OR 2.67, 95%CI 1.29 - 5.13, P = 0.008), collateral circulation grade ≤ 1 (OR 1.86, 95%CI 1.27 - 2.73, P = 0.008), and Killip classes (OR 2.01, 95%CI 1.01 - 3.94, P = 0.042) were independent predictors of no-reflow post primary PCI.

CONCLUSIONS

The plasma level of uric acid on admission is a strong and independent predictor of poor coronary blood flow following at post-primary PCI among STEMI patients. Uric acid levels may be a useful biomarker of risk stratification.

摘要

目的

探讨接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者尿酸水平与冠状动脉血流的关系。

方法

共纳入276例接受直接PCI的STEMI患者，并根据心肌梗死溶栓（TIMI）血流分级分为2组。无复流定义为TIMI 0级、1级和2级血流。采用多因素Logistic回归分析评估入院时尿酸水平与PCI术后TIMI血流分级的关系。主要不良心脏事件（MACE）定义为死亡、非致命性心肌梗死以及需要再次进行经皮血管重建或冠状动脉旁路移植术。

结果

无复流组（n = 57）的尿酸水平显著高于正常血流组（n = 219，372±111 vs 303±102，P < 0.01）。无复流患者的院内MACE显著更高（8.8% vs 1.8%，P = 0.016）。在ROC曲线分析中，入院时测得的尿酸水平≥345 mmol/L预测无复流的敏感性为61.2%，特异性为77.5%。在多因素分析中，高血浆尿酸（OR 1.01，95%CI 1.01 - 1.01，P < 0.01）、中性粒细胞计数（OR 1.02，95%CI 1.00 - 1.06，P < 0.01）、入院时血浆葡萄糖（OR 1.14，95%CI 1.08 - 1.21，P < 0.01）、胸痛至PCI的时间（OR 1.67，95%CI 0.46 - 5.97，P = 0.012）、PCI术前血栓评分≥4（OR 2.67，95%CI 1.29 - 5.13，P = 0.008）、侧支循环分级≤1（OR 1.86，95%CI 1.27 - 2.73，P = 0.008）以及Killip分级（OR 2.01，95%CI 1.01 - 3.94，P = 0.042）是直接PCI术后无复流的独立预测因素。