您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (11): 9-15.doi: 10.6040/j.issn.1671-7554.0.2019.358

• 临床医学 • 上一篇    

182例急性ST段抬高型心肌梗死患者术后30 d冠脉慢血流/无复流危险因素分析

张伟,赵红艳,杜凤立,苏国英   

  1. 山东大学附属济南市中心医院心血管内科, 山东 济南 250013
  • 发布日期:2022-09-27
  • 通讯作者: 赵红艳. E-mail: wei.229@163.com

Risk factors of slow or no coronary flow in 182 patients with acute ST-segment elevation myocardial infarction 30 days after operation

ZHANG Wei, ZHAO Hongyan, DU Fengli, SU Guoying   

  1. Department of Cardiology, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, Shandong, China
  • Published:2022-09-27

PDF (PC)

5

摘要： 目的 研究急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后冠状动脉慢血流/无复流(SCF/NCF)现象发生的危险因素,探讨术后30 d SCF/NCF对患者的影响。 方法 回顾性分析STEMI并行急诊PCI的患者334例,分为SCF/NCF组(n=182)及对照组(术后冠状动脉血流速度正常患者,n=152)。应用多因素二元Logistic回归分析研究STEMI患者急诊PCI术后与SCF/NCF现象发生有关联的危险因素,并于术后30 d内对所有患者进行随访,分析两组主要心脏不良事件(MACE)、再发心肌梗死、心源性死亡、全因死亡、支架内血栓的发生情况。 结果 (1)两组患者间差异存在统计学意义的因素包括:血肌酐值升高(P=0.034,OR=1.009,95%CI:1.001~1.017),预扩后高TIMI帧数(P=0.025,OR=1.038,95%CI:1.005~1.072),高支架最大释放压(P=0.006,OR=1.525,95%CI:1.130~2.060),高血栓积分(P=0.030,OR=1.324,95%CI:1.028~1.705)是SCF/NCF发生的危险因素;靶血管为非RCA(P<0.001,OR=0.071,95%CI:0.025~0.200),高预扩囊最大扩张压(P=0.033,OR=0.864,95%CI:0.755~0.989),术中应用硝普钠(P=0.006,OR=0.126,95%CI:0.029~0.548)及IIb/IIIa受体拮抗剂(P=0.043,OR=0.438,95%CI:0.197~0.974)是SCF/NCF发生的保护性因素;其中靶血管为非RCA及术中应用硝普钠为减低SCF/NCF现象发生的主要保护性因素。(2)术后30 d内随访表明,两组患者MACE(14例 vs 8例, χ2=0.753,P=0.385)、心源性死亡(12例 vs 8例,χ2=0.243,P=0.622)、全因死亡(12例 vs 8例, χ2=0.243,P=0.622)、支架内血栓(2例 vs 0例, χ2=1.675,P=0.196)的发生情况无统计学意义;而SCF/NCF组再发心肌梗死的发生率高于对照组(6例 vs 0例, χ2=5.087,P=0.024)。(3)导致两组患者死亡的原因包括心源性休克、支架内血栓、心脏破裂、急性心力衰竭,其中心源性休克是导致STEMI患者死亡的首位原因(占比70%)。 结论 血肌酐值升高、预扩后高TIMI帧数、高支架最大释放压、高血栓积分与SCF/NCF的发生有统计学意义的正向关联,靶血管为非RCA、高预扩球囊最大扩张压、术中使用硝普钠以及IIb/IIIa受体拮抗剂与SCF/NCF的发生有统计学意义的负向关联。随访发现SCF/NCF组再发心肌梗死的发生率高于对照组。

关键词: 急性ST段抬高型心肌梗死, 急诊经皮冠状动脉介入治疗, 冠状动脉慢血流, 冠状动脉无复流, 危险因素, 随访

Abstract: Objective To study the risk factors of slow coronary flow/ no coronary flow(SCF/NCF)after the emergency percutaneous coronary intervention(PCI)in the patients with acute ST-segment elevation myocardial infarction 山 东 大 学 学 报 (医 学 版)57卷11期 -张伟,等.182例急性ST段抬高型心肌梗死患者术后30 d冠脉慢血流/无复流危险因素分析 \=-(STEMI), and to explore the influences of SCF/NCF on the patients 30 days after the emergency PCI. Methods A total of 334 patients with STEMI and emergency PCI were analyzed retrospectively. They were divided into the SCF/NCF group(n=182)and control group(the patients with normal coronary flow after PCI,n=152). The multivariate Logistic regression analysis was used to study the risk factors correlated with SCF/NCF after emergency PCI. The follow-up was made to explore the incidence of major adverse cardiac events(MACE), myocardial re-infarction, cardiac death, all-cause death and instent thrombosis between the two groups 30 days after PCI. Results (1) The factors with statistical differences between the two groups showed that the elevation of serum creatinine(P=0.034, OR=1.009, 95%CI: 1.001-1.017), high TIMI frame counts after pre-dilation(P=0.025, OR=1.038, 95%CI: 1.005-1.072), the high maximum stent release pressure(P=0.006, OR=1.525, 95%CI: 1.130-2.060), the high thrombus score(P=0.030, OR=1.324, 95%CI: 1.028-1.705)were the risk factors of SCF/NCF phenomenon. Non-right coronary artery as the target vessel(P<0.001, OR=0.071, 95%CI: 0.025-0.200), the high maximum pre-dilation pressure(P=0.033, OR=0.864, 95%CI: 0.755-0.989), the usage of sodium nitroprusside(P=0.006, OR=0.126, 95%CI: 0.029-0.548)and IIb/IIIa receptor antagonist(P=0.043, OR=0.438, 95%CI: 0.197-0.974)during the procedure were the protection factors of the SCF/NCF phenomenon. Among these protection factors, non-right coronary artery as the target vessel and the usage of sodium nitroprusside were dominant. (2) After 30 days of the follow-up, there were no significant differences in the incidence of MACE(14 vs 8 cases, χ2=0.753, P=0.385), cardiac death(12 vs 8 cases, χ2=0.243, P=0.622), all-cause death(12 vs 8 cases, χ2=0.243,P=0.622)and in-stent thrombosis(2 vs 0 cases, χ2=1.675, P=0.196)between the two groups. Compared with the control group, the incidence of myocardial re-infarction in SCF/NCF group was higher(6 vs 0 cases, χ2=5.087, P=0.024). (3) The causes of death were cardiac shock, in-stent thrombosis, cardiac rupture and acute heart failure. Cardiac shock is the first cause of death which accounts for 70%. Conclusion The elevation of serum creatinine, high TIMI frame count after pre-dilation, the high maximum stent release pressure and the high thrombus score are positivly correlated to the SCF/NCF phenomenon. Non-right coronary artery as the target vessel, the high maximum pre-dilation pressure, the usage of sodium nitroprusside and IIb/IIIa receptor antagonist during the procedure are negativly correlated to the SCF/NCF phenomenon. The incidence of myocardial re-infarction in the SCF/NCF group was higher than that in the control group.

Key words: Acute ST-segment elevation myocardial infarction, Emergency percutaneous coronary intervention, Slow coronary flow, No coronary flow, Risk factors, Follow-up

中图分类号: 

  • R543.3
[1] Pedersen F, Butrymovich V, Kelbaek H, et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI[J]. J Am Coll Cardiol, 2014, 64(20): 2101-2108.
[2] Fokkema ML, James SK, Albertsson P, et al. Population trends in percutaneous coronary intervention: 20-year results from the SCAAR(Swedish Coronary Angiography and Angioplasty Registry)[J]. J Am Coll Cardiol, 2013, 61(12): 1222-1230.
[3] 叶绍东,吴永健,李琳,等.75岁以上ST段抬高心肌梗死患者再灌注治疗进展[J].中华老年心脑血管病杂志, 2015, 17(4): 436-437.
[4] Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow[J]. Circulation, 1996, 93(5): 879-888.
[5] 顾崇怀,邓宇阳,杨晓旭,等.血栓抽吸的应用现状及进展[J].中国介入心脏病学杂志,2014, 22(7):462-464.
[6] Salinas P, Jimenez-Valero S, Moreno R, et al. Update in pharmacological management of coronary no-reflow phenomenon[J]. Cardiovasc Hematol Agents Med Chem, 2012, 10(3): 256-264.
[7] 韩雅玲,邓捷,荆全民,等.急性心肌梗死急诊介入治疗无再流发生的独立预测因素及对长期预后的影响[J].中华心血管病杂志,2006, 34(6): 483-486. HAN Yaling, DNEG Jie, JING Quanmin, et al. Post primary percutaneous coronary intervention no-reflow in patients with acute myocardial infarction: contributing factors and long-term prognostic impact[J]. Chin J Cardiol, 2006, 34(6): 483-486.
[8] Gupta S, Gupta MM. No reflow phenomenon in percutaneous coronary interventions in ST-segment elevation myocardial infarc-tion[J]. Indian Heart J, 2016, 68(4): 539-551.
[9] 戴敬,吕树铮,宋现涛,等.介入术后无复流现象的研究进展[J].心肺血管病杂志, 2014, 33(1): 133-135.
[10] 赵林,张宇晨,郭成军,等.入院肾小球滤过率对ST段抬高心肌梗死患者急诊介入治疗术后心肌灌注及预后的影响[J]. 中国介入心脏病学杂志,2012,20(5): 262-266. ZHAO Lin, ZHANG Yuchen, GUO Chengjun, et al. Effect of admission estimated glomerular filtration rate on myocardial perfusion and prognosis in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention[J]. Chin J Intervent Cardiol, 2012, 20(5): 262-266.
[11] 王祥. 隐性肾功能不全对冠脉病变及临床预后的影响分析[D].长春:吉林大学,2014.
[12] 李凤丽,任法鑫,董梅.肾功能不全与心肌无复流关系的研究进展[J].医学综述, 2017, 23(6): 3245-3249. LI Fengli, REN Faxin, DONG Mei. Research progress of relationship between renal insufficiency and myocardial no-refolw[J]. Medical Recapitulate, 2017, 23(6): 3245-3249.
[13] Bolognese L, Falsini G, Liistro F, et al. Randomized comparison of upstream tirofiban versus downstream high bolus dose tirofiban or abciximab on tissue-level perfusion and troponin release in high-risk acute coronary syndromes treated with percutaneous coronary interventions: the EVEREST trial[J]. J Am Coll Cardiol, 2006, 47(3): 522-528.
[14] Kaul S. The “no reflow” phenomenon following acute myocardial infarction: mechanisms and treatment options[J]. J Cardiol, 2014, 64(2): 77-85.
[15] Wong DT, Puri R, Richardson JD, et al. Myocardial 'no-reflow' -diagnosis, pathophysiology and treatment[J]. Int J Cardiol, 2013, 167(5): 1798-1806.
[16] Uyarel H, Ergelen M, Cicek G, et al. Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction[J]. Coronary Artery Dis, 2011, 22(3): 138-144.
[17] Azab B, Torbey E, Hatoum H, et al. Usefulness of red cell distribution width in predicting all-cause long-term mortality after non-ST-elevation myocardial infarction[J]. Cardiology, 2011, 119(2): 72-80.
[18] Campagna JA, Carter C. Clinical relevance of the Bezold-Jarisch reflex[J]. Anesthesiology, 2003, 98(5): 1250-1260.
[19] Esente P, Giambartolomei A, Gensini GG, et al. Coronary reperfusion and Bezold-Jarisch reflex(bradycardia and hypotension)[J]. Am J Cardiol, 1983, 52(3): 221-224.
[20] 陈泽江,黄修献,李昭祺.替罗非班联合硝普钠对急诊PCI术中无复流现象的疗效观察[J].湖南师范大学学报(医学版), 2018, 15(6): 123-126. CHEN Zejiang, HUANG Xiuxian, LI Zhaoqi. Efficacy of tirofiban combined with sodium nitroprusside in the treatment of no-reflow phenomenon during emergency PCI[J]. J Hunan Normal Univ(Med Sci), 2018, 15(6): 123-126.
[21] Klein LW, Kern MJ, Berger P, et al. Society of cardiac angiography and interventions: suggested management of the no-reflow phenomenon on the cardiac catheterization laboratory[J]. Cather Cardiovasc Interv, 2003, 60(2): 194-201.
[22] Muller O, Trana C, Eeckhout E. Myocardial no-reflow treatment[J]. Curr Vasc Pharmacol, 2013, 11(2): 278-285.
[23] Gupta S, Gupta MM. No reflow phenomenon in percutaneous coronary interventions in ST-segment elevation myocardial infarction[J]. Indian Heart J, 2016, 68(4): 539-551.
[24] 任晖,黄立勋,庄贵华,等.急性心肌梗死急诊经皮冠状动脉介入治疗患者院内死亡因素分析[J].心脏杂志,2014,26(6): 662-665. REN Hui, HUANG Lixun, ZHUANG Guihua, et al. Analysis of in-hospital death in acute myocardial infarction patients treated with emergency percutaneous coronary intervention[J].Chin Heart J, 2014, 26(6): 662-665.
[25] Ndrepepa G, Tiroch K, Fusaro M, et al. 5-year prognostic value of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction[J]. J Am Coll Cardiol, 2010, 55(21): 2383-2389.
[1] 姚雪,卢冉冉,孙淑玲,高翠平,肖茹,王书会. 风湿性心脏病患者瓣膜置换术后医院感染风险预测评分模型的构建[J]. 山东大学学报 (医学版), 2022, 60(6): 90-96.
[2] 杨丛品,罗卓野,许秀华,李爱民,郝桂敏. 河北省某医院体检3 512例育龄女性生育选择及压力现状[J]. 山东大学学报 (医学版), 2022, 60(4): 62-67.
[3] 孔昕欣,孙书珍,李倩,陈元,周爱华,王莉,姚秀俊. 抗H因子抗体阳性溶血尿毒综合征7例分析[J]. 山东大学学报 (医学版), 2022, 60(4): 82-86.
[4] 吕岩红,张志勉. 2 809名体检人群中高血压与幽门螺杆菌感染的关联性[J]. 山东大学学报 (医学版), 2022, 60(2): 43-47.
[5] 陈丽宇,肖娟,吕仙忠,段宝敏,洪凡真. 影响孕产妇下肢深静脉血栓预后的危险因素分析[J]. 山东大学学报 (医学版), 2021, 59(7): 38-42.
[6] 司海朋,张文灿,李乐,周鑫. Kümmell's病的危险因素和诊治研究进展[J]. 山东大学学报 (医学版), 2021, 59(6): 25-32.
[7] 王纬,王凤琴,韩艳丽. 腹腔镜下右附件囊肿剥除术后发生心脏骤停1例[J]. 山东大学学报 (医学版), 2021, 59(11): 123-124.
[8] 孙胜房,马会力,贾竹亭,李民涛. 车祸所致880例四肢开放性损伤并发早期感染的危险性因素分析[J]. 山东大学学报 (医学版), 2021, 59(1): 72-77.
[9] 陈擎仪,张烜,王娟,孙继伟,曹丹凤, 曹枫林. 妊娠期女性自杀意念的危险因素及其累积效应[J]. 山东大学学报 (医学版), 2021, 59(1): 91-94.
[10] 宋立,张艳,刘洋,王丹. 随访2年观察1例新发突变的营养不良型大疱性表皮松解症[J]. 山东大学学报 (医学版), 2020, 1(8): 120-122.
[11] 张宁,杨燕,李锐,殷运红,李昊,曲仪庆. 慢阻肺患者感染鲍曼不动杆菌危险因素及耐药性分析[J]. 山东大学学报 (医学版), 2019, 57(9): 88-96.
[12] 陈琳琳,衣少雷,王蔚宗,李展,张勇,张玉娇,任满意,解新星,刘同宝,侯应龙. 预测心房颤动患者射频消融术后复发的危险因素[J]. 山东大学学报 (医学版), 2019, 57(3): 49-57.
[13] 赵亚妮,栾晓嵘,李海燕. 175例烟雾病血管重建术后12例发生脑梗死的危险因素分析[J]. 山东大学学报 (医学版), 2019, 57(10): 93-100.
[14] 王春明,刘钦成,郭凌宏,廖彩仙. 胰十二指肠切除术后出血的危险因素及其治疗[J]. 山东大学学报 (医学版), 2019, 57(1): 81-86.
[15] 余之刚,周飞. 非哺乳期感染性乳腺脓肿诊疗策略[J]. 山东大学学报 (医学版), 2018, 56(9): 1-5.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发