在接受直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者中，高岭土诱导的最大幅度与慢血流/无复流的关系。
Association between kaolin-induced maximum amplitude and slow-flow/no-reflow in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention.
机构信息
Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
出版信息
Int J Cardiol. 2022 Dec 15;369:13-18. doi: 10.1016/j.ijcard.2022.08.025. Epub 2022 Aug 12.
BACKGROUND
ST-segment elevation myocardial infarction (STEMI) patients with a high thrombus burden have a relatively high slow-flow/no-reflow risk. However, the association between kaolin-induced maximum amplitude (MA) and slow-flow/no-reflow has been scarcely explored.
METHODS
STEMI patients treated with primary percutaneous coronary intervention (PCI) were retrospectively enrolled from January 2015 to December 2019 at China-Japan Friendship Hospital. MA levels were measured using thromboelastography before the PCI procedure. The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI) flow grade after primary PCI: the normal flow group (TIMI flow grade = 3) and slow-flow/no-reflow (TIMI flow grade ≤ 2). The logistic regression model and restricted cubic spline regression (RCS) were used to analyze the predictive value of MA for slow-flow/no-reflow. All patients were followed up after discharge and observed the adverse cardiovascular events between the two groups.
RESULTS
A total of 690 patients were enrolled, with 108(15.7%) having slow-flow/no-reflow. The multivariate logistic regression model analysis showed that MA level was an independent risk factor for slow-flow/no-reflow. The RCS analysis showed a nonlinear relationship between MA levels and slow-flow/no-reflow. The cut-off value of MA levels for predicting slow-flow/no-reflow was 68 mm. During a median follow-up time of 4.4 years, slow-flow/no-reflow (hazard ratio 1.93, 95% confidence interval 1.27-2.93, P = 0.002) and MA levels (hazard ratio 1.06, 95% confidence interval 1.03-1.08, P < 0.001) were independent risk factors for predicting the long-term of adverse clinical cardiovascular events.
CONCLUSION
MA was an independent risk factor for predicting slow-flow/ no-reflow in STEMI patients who underwent primary PCI.
背景
ST 段抬高型心肌梗死（STEMI）患者血栓负荷较高，其慢血流/无复流风险相对较高。然而，高岭土诱导的最大振幅（MA）与慢血流/无复流之间的关系尚未得到充分探索。
方法
本研究回顾性纳入 2015 年 1 月至 2019 年 12 月在中国医学科学院北京协和医院接受直接经皮冠状动脉介入治疗（PCI）的 STEMI 患者。在 PCI 术前使用血栓弹力图测量 MA 水平。根据直接 PCI 术后心肌梗死溶栓治疗（TIMI）血流分级，将患者分为两组：正常血流组（TIMI 血流分级=3 级）和慢血流/无复流组（TIMI 血流分级≤2 级）。采用逻辑回归模型和限制性立方样条回归（RCS）分析 MA 对慢血流/无复流的预测价值。所有患者出院后进行随访，观察两组之间的不良心血管事件。
结果
共纳入 690 例患者，其中 108 例（15.7%）发生慢血流/无复流。多因素逻辑回归模型分析显示，MA 水平是慢血流/无复流的独立危险因素。RCS 分析显示，MA 水平与慢血流/无复流之间存在非线性关系。MA 水平预测慢血流/无复流的截断值为 68mm。中位随访时间 4.4 年期间，慢血流/无复流（危险比 1.93，95%置信区间 1.27-2.93，P=0.002）和 MA 水平（危险比 1.06，95%置信区间 1.03-1.08，P<0.001）是预测长期不良临床心血管事件的独立危险因素。
结论
MA 是直接 PCI 治疗的 STEMI 患者预测慢血流/无复流的独立危险因素。
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