Kurtul Alparslan, Murat Sani Namik, Yarlioglues Mikail, Duran Mustafa, Celik Ibrahim Etem, Kilic Alparslan
Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.
Angiology. 2015 Aug;66(7):644-51. doi: 10.1177/0003319714546738. Epub 2014 Aug 13.
We investigated whether admission estimated glomerular filtration rate (eGFR) values are associated with no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Patients (n = 673; 59 ± 13 years; 77.1% men) were stratified into 3 groups according to eGFR at admission: normal renal function (eGFR ≥ 90 mL/min/1.73 m2), mild renal impairment (eGFR 60-89 mL/min/1.73 m2), and moderate renal impairment (eGFR 30-59 mL/min/1.73 m2). No-reflow phenomenon was defined as thrombolysis in myocardial infarction flow grade <3 after pPCI. The rate of no-reflow gradually increased from the normal renal function group to the moderate impaired renal function group (P < .001). Multivariate analysis showed that eGFR (odds ratio [OR] 0.942, P < .001), Killip ≥2 class (OR 3.968, P = .008), left ventricular ejection fraction (OR 0.959, P = .034), and early patency of infarct vessel (OR 0.186, P < .001) were independent predictors of no-reflow phenomenon. Mild to moderate renal impairment at admission is independently associated with no-reflow phenomenon after pPCI.
我们研究了在接受直接经皮冠状动脉介入治疗（pPCI）的ST段抬高型心肌梗死（STEMI）患者中，入院时估算肾小球滤过率（eGFR）值是否与无复流现象相关。患者（n = 673；59±13岁；77.1%为男性）根据入院时的eGFR被分为3组：肾功能正常（eGFR≥90 mL/min/1.73 m²）、轻度肾功能损害（eGFR 60 - 89 mL/min/1.73 m²）和中度肾功能损害（eGFR 30 - 59 mL/min/1.73 m²）。无复流现象定义为pPCI后心肌梗死溶栓血流分级<3。无复流发生率从肾功能正常组到中度肾功能损害组逐渐升高（P < 0.001）。多变量分析显示，eGFR（比值比[OR] 0.942，P < 0.001）、Killip≥2级（OR 3.968，P = 0.008）、左心室射血分数（OR 0.959，P = 0.034）和梗死血管早期开通情况（OR 0.186，P < 0.001）是无复流现象的独立预测因素。入院时轻度至中度肾功能损害与pPCI后无复流现象独立相关。
