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修正休克指数和支架覆盖表面积对急性ST段抬高型心肌梗死患者冠状动脉介入术中无复流的影响

Influence of modified shock index and stent coverage surface area on no-reflow phenomenon in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

    摘要
  • 摘要:
    目的 探讨修正休克指数（modified shock index，MSI）和支架覆盖表面积（stent coverage surface area，SCSA）对急性ST段抬高型心肌梗死（ST-elevation myocardial infarction，STEMI）患者急诊经皮冠状动脉介入（percutaneous coronary intervention，PCI）术中发生无复流现象（no-reflow phenomenon，NRP）的影响。
    方法 选择2018年6月至2019年6月复旦大学附属中山医院收治的行急诊PCI术的STEMI患者231例。根据PCI过程中梗死相关动脉TIMI血流分级，将患者分为NRP组（TIMI 0~2级，n=48）和正常血流组（TIMI 3级，n=183）。以有创监测的心率与收缩压或平均动脉压比值计算休克指数（shock index，SI）或修正休克指数（modified SI，MSI）；以支架直径（D支架）、长度与圆周率的乘积计算SCSA。对NRP的危险因素进行多因素logistic回归分析。
    结果 与正常血流组相比，NRP组患者年龄更大，糖尿病史、Killip分级为Ⅲ/Ⅳ级的比例更高，收缩压、舒张压和平均动脉压降低；SBP < 100 mmHg（1 mmHg=0.133 kPa）患者比例、SI、MSI、D支架和SCSA增大（P < 0.05）。NRP组患者预后较差，院内死亡率明显高于正常血流组（6.3%vs 0.5%，P=0.030）。MSI≥1.2、SI≥0.7和SBP < 100 mmHg时，患者发生NRP危险度分别是3.365、3.025和2.957（P < 0.05）；SCSA≥350 mm2和D支架>3.0 mm时，患者发生NRP的危险度为2.836和2.138（P < 0.05）。
    结论 MSI≥1.2和SCSA≥350 mm2是急性STEMI患者PCI术中NRP发生的独立危险因素，NRP患者院内死亡率高。

     

    Abstract:
    Objective To explore the influence of the modified shock index (MSI) and stent coverage surface area (SCSA) on the no-reflow phenomenon (NRP) in acute ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
    Methods A total of 231 STEMI patients who underwent emergency PCI were enrolled in Zhongshan Hospital, Fudan University from June 2018 to June 2019. According to thrombolysis in myocardial infarction (TIMI) blood flow grading of infarct-associated artery during PCI, the patients were divided into NRP group (TIMI grade 0-2, n=48) and normal flow group (TIMI grade 3, n=183). The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) at the beginning of PCI were recorded, and shock index (SI) or modified SI (MSI) was calculated by the ratio of HR and SBP or MAP. The mean diameter (D) and total length (L) of all implanted stents were recorded, and SCSA was calculated as formula π×D×L. The related factors of NRP were analyzed by multivariate logistic regression.
    Results Compared with the normal blood flow group, age, history of diabetes ratio, and Killip grade Ⅲ/Ⅳ ratio in the NRP group increased significantly, the SBP, DBP, and MAP were significantly decreased, and the SI, MSI, D, and SCSA were significantly increased (all P < 0.05). Patients with NRP were associated with poor prognosis, and in-hospital mortality was significantly higher in the NRP group than that in the normal blood flow group (6.3% vs 0.5%, P=0.030). When MSI≥1.2, SI≥0.7, and SBP < 100 mmHg, the odds ratio to predicate NRP risk were 3.365, 3.025, and 2.957, respectively(P < 0..05). Similarly, when SCSA≥350 mm2 and D>3.0 mm, the odds ratio to predicate NRP risk were 2.836 and 2.138(P < 0.05).
    Conclusions MSI≥1.2 and SCSA≥350 mm2 maybe independent risk factors for NRP in patients with primary STEMI undergoing PCI, and the patients with NRP have high in-hospital mortality.

     

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