急性心肌梗死急诊介入后无复流的预测模型  

The factors studied for prediction of coronary no-reflow in patients with STEMI after emergency coronary intervention with primary drug-eluted stenting

作　　者：王长华[1] 陈韵岱[2] 杨新春[3] 王乐丰[3] 王红石[3] 孙志军[2] 刘宏斌[2] 陈练[2] 

机构地区：[1]北京安贞医院心内科,北京100029 [2]解放军总医院心内科 [3]北京朝阳医院心内科

出　　处：《中华急诊医学杂志》2011年第11期1170-1173,共4页Chinese Journal of Emergency Medicine

基　　金：北京市科委科技支撑项目（Z09050700620909）

摘　　要：目的研究急性ST段抬高型心肌梗死（ST—elevation myocardiali nfarction，STEMI）患者急诊药物支架置入后无复流的独立预测因素。方法收集2007年1月至2010年3月在解放军总医院和北京朝阳医院住院，在发病后12h内成功行急诊药物支架置入的1413例STEMI患者资料进行前瞻性分析，分为无复流组和复流正常组。采用单变量和多元logistic回归分析识别无复流的独立预测因素。结果在1413例患者中，297例发生无复流（21．0％）。多元logistic回归分析发现，年龄〉65岁、再灌注时间〉6h、侧支血流≤1级、人院血糖（admission plasma glucose，APG）〉13．0mmol／L、经皮冠状动脉介入治疗（persutaneous coronary intervention，PCI）前血栓评分I〉4分和PCI前主动脉内气囊反搏（intra—aortic balloon pump，IABP）使用是无复流的独立预测因素（P〈0．05）。无复流发生率随着独立预测因素增加而显著增高（P〈0．01）。结论STEMI患者急诊药物支架置入后无复流预测模型由6个因素组成：年龄〉65岁、再灌注时问〉6h、侧支血流≤1级、APG〉13．0mmol／L、PCI前血栓评分／〉4分和PCI前IABP使用。Objective To assess independent no-reflow predictors in patients with STEMI after primary drug-eluted stenting. Method A prospective study was carried out in 1413 patients with STEMI treated with primary drug-eluted stenting within 12 hours after onset of AMI from January 2007 through March 2010. The patients were divided into the no-reflow group and the normal reflow group. Univariate and multivariate logistic regression were applied to identification of no-reflow predictors. Results The no-reflow was found in 297 （21.0%） of 1413 patients. Univariate and multivariate logistic regression identified that age 〉 65 years, long time from onset to reperfusion 〉 6 hours, admission plasma glucose （APG） 〉 13.0 mmol/L, collateral circulation ≤1, pre-percutaneous coronary intervention （ PCI ） thrombus score ≥ 4, and intra-aortic balloon pump （IABP） used before PCI （P 〈 0. 05） were independent no-reflow predictors. The no-reflow rate significantly increased as the number of predictors increased （ P 〈 0. 01 ）. Conclusions There are 6 factors associated with coronary no-reflow used for prediction in patients with STEMI after primary drug-eluted stenting.

关 键 词：急性ST段抬高型心肌梗死 急诊药物支架置入 无复流 

分 类 号：R542.22[医药卫生—心血管疾病]