ST段抬高型心肌梗死患者梗死相关动脉介入前通畅的预测因素：中性粒细胞与淋巴细胞比值及尿酸水平的重要性
Predictors of preinterventional patency of infarct-related artery in patients with ST-segment elevation myocardial infarction: Importance of neutrophil to lymphocyte ratio and uric acid level.
作者信息
Sahin Durmuş Yıldıray, Gür Mustafa, Elbasan Zafer, Yıldız Ali, Kaya Zekeriya, Içen Yahya Kemal, Kıvrak Ali, Türkoğlu Caner, Yılmaz Remzi, Caylı Murat
机构信息
Adana Numune Education and Research Hospital, Department of Cardiology, Adana;
出版信息
Exp Clin Cardiol. 2013 Spring;18(2):e77-81.
BACKGROUND
Patients with ST-segment elevation myocardial infarction (STEMI) and a patent infarct-related artery (IRA) experience lower mortality and better clinical outcome, but little is known about the predictors of IRA patency before primary percutaneous coronary intervention (PCI) in the setting of STEMI.
OBJECTIVE
To assess possible predictors of patency of IRA before primary PCI in patients with STEMI.
METHODS
A total of 880 patients with STEMI undergoing primary PCI were prospectively included (646 male, 234 female; mean [± SD] age 58.5±12.4 years). Blood samples were obtained on admission to investigate biochemical markers. Preinterventional thrombolysis in myocardial infarction (TIMI) flow was assessed in all patients. The patients were divided into two groups according to the pre-PCI TIMI flow as impaired flow group (TIMI flow 0, 1 and 2) and normal flow group (TIMI flow 3). Transthoracic echocardiography was performed in all patients.
RESULTS
Eighty-three (9.43%) patients had pre-PCI TIMI 3 flow in IRA. Uric acid levels and neutrophil to lymphocyte (N to L) ratio in the normal flow group were lower than in the impaired flow group (P<0.001 for both). However, ejection fraction (EF) was higher in the normal flow group than in the impaired flow group. Multivariate logistic regression analysis showed that IRA patency was independently associated with serum uric acid level (β 0.673 [95% CI 0.548 to 0.826]; P<0.001), N to L ratio (β 0.783 [95% CI 0.683 to 0.897]; P<0.001) and EF (β 1.033 [95% CI 1.006 to 1.061]; P=0.016).
CONCLUSION
Serum uric acid level, N to L ratio and EF are independent predictors of the pre-PCI patency of IRA in patients with STEMI undergoing primary PCI.
背景
ST段抬高型心肌梗死（STEMI）且梗死相关动脉（IRA）通畅的患者死亡率较低，临床结局较好，但对于STEMI患者在接受直接经皮冠状动脉介入治疗（PCI）前IRA通畅的预测因素知之甚少。
目的
评估STEMI患者在接受直接PCI前IRA通畅的可能预测因素。
方法
前瞻性纳入880例接受直接PCI的STEMI患者（男性646例，女性234例；平均年龄[±标准差]58.5±12.4岁）。入院时采集血样以检测生化标志物。对所有患者进行介入前心肌梗死溶栓（TIMI）血流评估。根据PCI前TIMI血流情况将患者分为两组，即血流受损组（TIMI血流0、1和2级）和正常血流组（TIMI血流3级）。对所有患者进行经胸超声心动图检查。
结果
83例（9.43%）患者的IRA在PCI前为TIMI 3级血流。正常血流组的尿酸水平和中性粒细胞与淋巴细胞（N/L）比值低于血流受损组（两者P<0.001）。然而，正常血流组的射血分数（EF）高于血流受损组。多因素逻辑回归分析显示，IRA通畅与血清尿酸水平（β0.673[95%可信区间0.548至0.826]；P<0.001）、N/L比值（β0.783[95%可信区间0.683至0.897]；P<0.001）和EF（β1.033[95%可信区间1.006至1.061]；P=0.016）独立相关。
结论
血清尿酸水平、N/L比值和EF是接受直接PCI的STEMI患者PCI前IRA通畅的独立预测因素。
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