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
Related Articles |
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.