Mazhar Jawad, Mashicharan Mary, Farshid Ahmad
The Canberra Hospital, Canberra, Yamba drive, Garran, ACT 2605, Australia.
Australian National University, Canberra, Australia.
Int J Cardiol Heart Vasc. 2015 Nov 6;10:8-12. doi: 10.1016/j.ijcha.2015.11.002. eCollection 2016 Mar.
No-reflow (TIMI < 3) during primary PCI (PCI) for STEMI occurs in 11-41% of cases, indicates poor myocardial tissue perfusion, and is associated with a poor outcome. We aimed to determine predictors and 12 month outcomes of patients who developed no-reflow.
We analysed the PCI database of The Canberra Hospital and identified 781 patients who underwent primary PCI during 2008-2012. Follow-up at 12 months was with letter, phone call and review of hospital records.
No-reflow was observed in 189 patients (25%) at the end of the procedure. Patients with no-reflow were older (64 vs. 61 years, p = 0.03). No-reflow patients were more likely to have initial TIMI flow < 3 (89% vs. 79%, p = 0.001), thrombus score ≥ 4 (83% vs. 69%, p = 0.0001), higher use of glycoprotein IIb/IIIa inhibitors (57% vs. 48%, p = 0.03) and longer median symptom to balloon time (223 min vs. 192 min, p = 0.004). No-reflow was an independent predictor of mortality (HR 1.95, CI 1.04-3.59, p = 0.037) during 12 month follow-up. On multivariate analysis, age > 60 years, thrombus score ≥ 4 and symptom to balloon time > 360 min were independent predictors of no-reflow. In 17% of cases of no reflow, it occurred only after stent insertion.
No-reflow occurred in 25% of STEMI patients undergoing primary PCI and was more likely with older age, high thrombus burden and delayed presentation. No-reflow was associated with a higher risk of death at 12 month follow-up.
ST段抬高型心肌梗死（STEMI）患者在直接经皮冠状动脉介入治疗（PCI）过程中出现无复流（心肌梗死溶栓试验（TIMI）血流分级<3级）的情况在11%至41%的病例中出现，提示心肌组织灌注不良，并与不良预后相关。我们旨在确定发生无复流的患者的预测因素和12个月的预后情况。
我们分析了堪培拉医院的PCI数据库，确定了781例在2008年至2012年期间接受直接PCI的患者。通过信件、电话及查阅医院记录对患者进行12个月的随访。
在手术结束时，189例患者（25%）出现无复流。出现无复流的患者年龄更大（64岁对61岁，p = 0.03）。无复流患者更可能初始TIMI血流分级<3级（89%对79%，p = 0.001）、血栓评分≥4分（83%对69%，p = 0.0001）、更高比例使用糖蛋白IIb/IIIa抑制剂（57%对48%，p = 0.03）以及更长的症状发作至球囊扩张时间中位数（223分钟对192分钟，p = 0.004）。无复流是12个月随访期间死亡率的独立预测因素（风险比1.95，可信区间1.04 - 3.59，p = 0.037）。多因素分析显示，年龄>60岁、血栓评分≥4分以及症状发作至球囊扩张时间>360分钟是无复流的独立预测因素。在17%的无复流病例中，无复流仅在支架置入后出现。
在接受直接PCI的STEMI患者中，25%出现无复流，年龄较大、血栓负荷高及就诊延迟时更易发生。无复流与12个月随访时更高的死亡风险相关。
