Yang Li, Cong Hongliang, Lu Yali, Chen Xiaolin, Liu Yin
Department of Cardiology, Tianjin Chest Hospital.
Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University.
Medicine (Baltimore). 2020 Jun 26;99(26):e20152. doi: 10.1097/MD.0000000000020152.
No-reflow is an important complication among patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).A retrospective study of 1658 STEMI patients undergoing direct PCI was performed. Patients were randomly assigned at a 7:3 ratio into development cohort and validation cohort and into no-reflow and normal blood flow groups. Clinical data and laboratory examinations were compared to identify independent risk factors and establish a no-reflow risk scoring system.In the development cohort (n = 1122), 331 (29.5%) had no-reflow. Multivariate analysis showed age ≥ 65 years (OR = 1.766, 95% confidence interval (CI): 1.313-2.376, P < .001), not using angiotonase inhibitor/angiotensin receptor antagonists (OR = 1.454, 95%CI: 1.084-1.951, P = .013), collateral circulation <grade 2 (OR = 3.056, 95%CI: 1.566-5.961, P = .001), thrombosis burden ≥4 points (OR = 2.033, 95%CI: 1.370-3.018, P < .001), diameter of target lesion ≥3.5 mm (OR = 1.511, 95%CI: 1.087-2.100, P = .014), thrombosis aspiration (OR = 1.422, 95%CI: 1.042-1.941, P = .026), and blood glucose >8 mmol/L (OR = 1.386, 95%CI: 1.007-1.908, P = .045) were related to no-reflow. Receiver operating characteristic (ROC) area under the curve was 0.648 (95%CI: 0.609-0.86). At 0.349 cutoff sensitivity was 42.0%, specificity was 79.3%, positive predictive value (PPV) was 44.7%, negative predictive value (NPV) was 77.4%, P < .001. The resulting risk scoring system was tested in the validation cohort (n = 536), with 30.1% incidence of no-reflow. The area under the ROC curve was 0.637 (95%CI: 0.582-0.692). At a cutoff of 0.349 sensitivity was 53.2% and specificity was 66.7%, PPV was 41.2%, NPV was 76.4%, P < .001.The no-reflow risk scoring system was effective in identifying high-risk patients.
无复流是接受经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI）患者的一种重要并发症。对1658例接受直接PCI的STEMI患者进行了一项回顾性研究。患者按7:3的比例随机分为开发队列和验证队列，以及无复流组和正常血流组。比较临床资料和实验室检查结果，以确定独立危险因素并建立无复流风险评分系统。在开发队列（n = 1122）中，331例（29.5%）发生无复流。多因素分析显示，年龄≥65岁（OR = 1.766，95%置信区间（CI）：1.313 - 2.376，P <.001）、未使用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂（OR = 1.454，95%CI：1.084 - 1.951，P = .013）、侧支循环<2级（OR = 3.056，95%CI：1.566 - 5.961，P = .001）、血栓负荷≥4分（OR = 2.033，95%CI：1.370 - 3.018，P <.001）、靶病变直径≥3.5 mm（OR = 1.511，95%CI：1.087 - 2.100，P = .014）、血栓抽吸（OR = 1.422，95%CI：1.042 - 1.941，P = .026）以及血糖>8 mmol/L（OR = 1.386，95%CI：1.007 - 1.908，P = .045）与无复流相关。受试者工作特征（ROC）曲线下面积为0.648（95%CI：0.609 - 0.86）。在截断值为0.349时，灵敏度为42.0%，特异度为79.3%，阳性预测值（PPV）为44.7%，阴性预测值（NPV）为77.4%，P <.001。所得风险评分系统在验证队列（n = 536）中进行了测试，无复流发生率为30.1%。ROC曲线下面积为0.637（95%CI：0.582 - 0.692）。在截断值为0.349时，灵敏度为53.2%，特异度为66.
