Wang Cheng, Wu Yan, Su Yang, Mao Bin, Luo Yihong, Yan Yexiang, Hu Kun, Lu Yi, Che Wenliang, Wan Minying
Department of Cardiology, Chongming Branch, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 66 East Xiangyang Road, Chongming, Shanghai, China.
Department of Cardiology, Shanghai Putuo District Liqun Hospital, Shanghai, 200333, China.
Int J Cardiovasc Imaging. 2022 Jun;38(6):1191-1202. doi: 10.1007/s10554-022-02529-8. Epub 2022 Feb 19.
To evaluate the association between circulating levels of inflammatory cytokines and the occurrence of post-percutaneous coronary intervention (PCI) coronary slow flow (CSF) in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). CSF after PCI commonly occurs and implies poor outcomes, while the determinants of post-PCI CSF in patients with NSTE-ACS remain controversial. In this multicenter case control study, 176 patients diagnosed with NSTE-ACS and with post-PCI CSF occurred composed of CSF group, while 352 matched NSTE-ACS patients composed control group. Corrected thrombolysis in myocardial infarction frame count (cTFC), circulating levels of inflammatory cytokines and PCI related parameters were analyzed using Logistic regression models. Among 528 patients with median age of 67 (59-76) and male proportion of 65.5%, 176 (35.0%) patients had occurrence of post-PCI CSF defined as cTFC ≥ 24. Patients with CSF presented more intense inflammatory activity revealed by higher levels of white blood cell, high-sensitivity C-reactive protein (hs-CRP), interleukin-1ß (IL-1ß), soluble IL-2 receptor (sIL-2R), IL-6, IL-8, IL-10 and tumor necrosis factor-α (TNF-α), while PCI related parameters were comparable. Correlation analysis showed cTFC was positively correlated with those inflammatory cytokines. Logistic regression model indicates that hs-CRP (odds ratio (OR) = 3.038, 95% confidence interval (CI) 1.545-5.975), sIL-2R (OR = 2.103, 95% CI 1.959-4.026) and TNF-α (OR = 3.708, 95% CI 1.426-9.641) were valuable predictors for CSF occurrence. Elevated circulating levels of inflammatory cytokine including hs-CRP, sIL-2R and TNF-α rather than PCI related parameters could predict post-PCI CSF in patients with NSTE-ACS.
评估非ST段抬高型急性冠脉综合征（NSTE-ACS）患者经皮冠状动脉介入治疗（PCI）后冠状动脉慢血流（CSF）的发生与循环炎症细胞因子水平之间的关联。PCI术后CSF较为常见且提示预后不良，而NSTE-ACS患者PCI术后CSF的决定因素仍存在争议。在这项多中心病例对照研究中，176例诊断为NSTE-ACS且发生PCI术后CSF的患者组成CSF组，352例匹配的NSTE-ACS患者组成对照组。使用Logistic回归模型分析校正的心肌梗死溶栓帧数（cTFC）、循环炎症细胞因子水平和PCI相关参数。在528例中位年龄为67岁（59-76岁）且男性比例为65.5%的患者中，176例（35.0%）患者发生了定义为cTFC≥24的PCI术后CSF。CSF患者表现出更强烈的炎症活动，表现为白细胞、高敏C反应蛋白（hs-CRP）、白细胞介素-1β（IL-1β）、可溶性IL-2受体（sIL-2R）、IL-6、IL-8、IL-10和肿瘤坏死因子-α（TNF-α）水平更高，而PCI相关参数相当。相关性分析显示cTFC与这些炎症细胞因子呈正相关。Logistic回归模型表明，hs-CRP（比值比（OR）=3.038，95%置信区间（CI）1.545-5.975）、sIL-2R（OR=2.103，95%CI 1.959-4.026）和TNF-α（OR=3.708，95%CI 1.426-9.641）是CSF发生的有价值预测指标。包括hs-CRP、sIL-2R和TNF-α在内的循环炎症细胞因子水平升高而非PCI相关参数可预测NSTE-ACS患者PCI术后CSF。
