Alidoosti Mohammad, Lotfi Reza, Lotfi-Tokaldany Masoumeh, Nematipour Ebrahim, Salarifar Mojtaba, Poorhosseini Hamidreza, Jalali Arash
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
J Tehran Heart Cent. 2018 Jul;13(3):108-114.
Despite recent advances in interventional equipment and techniques, the angiographic no-reflow phenomenon occurs in a considerable number of patients undergoing primary percutaneous coronary intervention (PCI). We investigated the clinical, angiographic, preprocedural, and procedural characteristics associated with the no-reflow phenomenon among patients undergoing primary PCI. Between March 2008 and April 2013, 530 patients (78.5% male, mean age=58.11±12.39 y) with ST-segment-elevation myocardial-infarction who underwent primary PCI were categorized in 2 groups according to their postprocedural thrombolysis-in-myocardial infarction (TIMI) flow grades: those with a maximum score of 2 (the no-reflow or slow-flow group) and the ones with a score of 3 (the reflow group). A multivariable logistic regression model was used to find the multiple correlates of the no-reflow phenomenon after PCI. There were 166 (31.3%) patients in the no-reflow group and 364 (68.7%) in the reflow group. The no-reflow patients were older and had significantly longer target lesion lengths, higher SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) scores, higher infarct-related artery SYNTAX scores, more thrombus burden, and a higher frequency of initial TIMI flow grades of 2 or lower. Our multivariable logistic regression analysis demonstrated that older age, higher numbers of Q waves, not using statin, longer target lesion lengths, higher thrombus grades, and higher infarct-related artery SYNTAX scores remained the independent correlates of increased no-reflow rates after primary PCI (area under the ROC curve=0.784, 95% CI: 0.742-0.826; P<0.001). Clinical, angiographic, and procedural features of patients undergoing primary PCI may be correlated with the occurrence of the no-reflow phenomenon. The thrombus grade and the infarct-related artery SYNTAX score could be among these factors.
尽管介入设备和技术最近取得了进展，但相当多接受直接经皮冠状动脉介入治疗（PCI）的患者会出现血管造影无复流现象。我们调查了接受直接PCI的患者中与无复流现象相关的临床、血管造影、术前和术中特征。在2008年3月至2013年4月期间，530例接受直接PCI的ST段抬高型心肌梗死患者（78.5%为男性，平均年龄=58.11±12.39岁）根据术后心肌梗死溶栓（TIMI）血流分级分为两组：最高评分为2分的患者（无复流或慢血流组）和评分为3分的患者（复流组）。采用多变量逻辑回归模型来寻找PCI术后无复流现象的多个相关因素。无复流组有166例（31.3%）患者，复流组有364例（68.7%）患者。无复流患者年龄较大，靶病变长度明显更长，经皮冠状动脉介入治疗与心脏手术协同作用（SYNTAX）评分更高，梗死相关动脉SYNTAX评分更高，血栓负荷更大，初始TIMI血流分级为2级或更低的频率更高。我们的多变量逻辑回归分析表明，年龄较大、Q波数量较多、未使用他汀类药物、靶病变长度较长、血栓分级较高以及梗死相关动脉SYNTAX评分较高仍然是直接PCI后无复流率增加的独立相关因素（ROC曲线下面积=0.784，95%CI：0.742-0.826；P<0.001）。接受直接PCI的患者的临床、血管造影和术中特征可能与无复流现象的发生相关。血栓分级和梗死相关动脉SYNTAX评分可能是这些因素之一。
