Liang Tian, Liu Min, Wu Chengyu, Zhang Qing, Lu Lei, Wang Zhongliang
Xuzhou City Hospital of TCM Affiliated to Nanjing University of Chinese Medicine, Xuzhou, Jiangsu Province, China.
Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China.
Rev Invest Clin. 2017 May-Jun;69(3):139-145. doi: 10.24875/ric.17002190.
To explore risk factors for no-reflow phenomenon after percutaneous coronary intervention in patients with acute coronary syndrome.
A total of 733 acute myocardial infarction patients with persistent ischemic chest pain within 12 or 12-24 hours after onset received emergency percutaneous coronary intervention. Patients were divided into a normal reflow group and a no-reflow group, according to TIMI grading and myocardial blush grading after percutaneous coronary intervention. Related risk factors were analyzed.
The incidence of no-reflow phenomenon after percutaneous coronary intervention was 16.1%. Univariate analysis showed that, compared with the normal reflow group, the no-reflow group was older, reperfusion time was significantly longer, preoperative systolic pressure was lower, troponin peak was higher, and creatine kinase enzyme peak was higher (p < 0.05). The proportions of preoperative cardiac function Killip grade ≥ 2 and number of patients using preoperative intra-aortic balloon pump were significantly different (p < 0.05). Multivariate logistic regression analysis showed that age > 65 years (OR: 1.471; 95% CI: 1.462-1.492; p = 0.007), reperfusion time > 6 hours (OR: 1.274; 95% CI: 1.164-1.405; p = 0.001), low systolic pressure at admission (< 100 mmHg) (OR: 1.918; 95% CI: 1.017-3.897; p = 0.004), intra-aortic balloon pump use before percutaneous coronary intervention (OR: 1.949; 95% CI: 1.168-3.253; p = 0.011), low TIMI grade (≤ 1) before percutaneous coronary intervention (OR: 1.100; 95% CI: 1.086-1.257; p < 0.01), high thrombus load (OR: 1.274; 95% CI: 1.423-2.761; p = 0.030), and long target lesion (OR: 1.948; 95% CI: 1.908-1.990; p = 0.019) were independent risk factors.
No-reflow phenomenon after percutaneous coronary intervention in patients with acute coronary syndrome was affected by complicated pathological factors.
探讨急性冠状动脉综合征患者经皮冠状动脉介入治疗后无复流现象的危险因素。
733例急性心肌梗死患者在发病12小时内或12 - 24小时内出现持续性缺血性胸痛，接受急诊经皮冠状动脉介入治疗。根据经皮冠状动脉介入治疗后的TIMI分级和心肌 blush分级，将患者分为正常复流组和无复流组。分析相关危险因素。
经皮冠状动脉介入治疗后无复流现象的发生率为16.1%。单因素分析显示，与正常复流组相比，无复流组年龄更大，再灌注时间明显更长，术前收缩压更低，肌钙蛋白峰值更高，肌酸激酶酶峰值更高（p < 0.05）。术前心功能Killip分级≥2级的比例和术前使用主动脉内球囊泵的患者数量有显著差异（p < 0.05）。多因素logistic回归分析显示，年龄>65岁（OR：1.471；95%CI：1.462 - 1.492；p = 0.007）、再灌注时间>6小时（OR：1.274；95%CI：1.164 - 1.405；p = 0.001）、入院时收缩压低（<100 mmHg）（OR：1.918；95%CI：1.017 - 3.897；p = 0.004）、经皮冠状动脉介入治疗前使用主动脉内球囊泵（OR：1.949；95%CI：1.168 - 3.253；p = 0.011）、经皮冠状动脉介入治疗前TIMI分级低（≤1）（OR：1.100；95%CI：1.086 - 1.257；p < 0.01）、血栓负荷高（OR：1.274；95%CI：1.423 - 2.761；p = 0.030）和靶病变长（OR：1.948；95%CI：1.908 - 1.990；p = 0.019）是独立危险因素。
急性冠状动脉综合征患者经皮冠状动脉介入治疗后的无复流现象受复杂病理因素影响。
