STEMI患者首诊时血清肌钙蛋白水平对急诊冠脉介入术中无复流的影响  

Effect of different serum troponin levels on admission on no-reflow during primary percutaneous coronary intervention in patients with STEMI

作　　者：陈章炜 卢淡泊 戴春峰 张亚琦 陈傲 夏妍 李晨光 姚康 马剑英 钱菊英 葛均波 CHEN Zhang-wei;LU Dan-bo;DAI Chun-feng;ZHANG Ya-qi;CHEN Ao;XIA Yan;LI Chen-guang;YAO Kang;MA Jian-ying;QIAN Ju-ying;GE Jun-bo(Department of Cardiology,Shanghai Institute of Cardiovascular Diseases,Zhongshan Hospital,Fudan University,National Clinical Research Center for Interventional Medicine,Shanghai Clinical Research Center for Interventional Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心内科,上海市心血管病研究所,国家放射与治疗临床医学研究中心,上海市放射与治疗(介入治疗)临床医学研究中心,上海200032

出　　处：《中国临床医学》2022年第3期322-327,共6页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(81870267,81970295);国家重点研发计划(2019YFC0840601);心馨心血管健康VG基金临床研究项目(2017-CCA-VG-036);上海市卫生系统优秀青年项目(2017YQ057);上海申康发展项目(SHDC12019104);心馨默克基金项目(Xinxin-merck-fund-051);上海市放射与治疗(介入治疗)临床医学研究中心(19MC1910300).

摘　　要：目的探讨术前超敏心肌肌钙蛋白T(cTnT)水平对急性ST段抬高型心肌梗死(STEMI)患者急诊冠脉介入术后无复流现象的影响及相关危险因素。方法纳入2013年1月至2015年2月复旦大学附属中山医院收治的因急性STEMI行急诊冠状动脉介入治疗的677例患者,分为术前cTnT<5倍正常参考值上限(URL)组(n=337)、cTnT 5~20倍URL组(n=141)和cTnT>20倍URL组(n=199)。分析术前cTnT不同水平与术后无复流的相关性,对术前不同cTnT水平亚组术后发生无复流的危险因素进行多因素logistic回归分析。结果cTnT<5倍URL组、cTnT 5~20倍URL组、cTnT>20倍URL组患者冠脉支架植入即刻TIMI血流0级或1级的比例分别为15.4%、19.1%、18.6%(P=0.499)。多因素logistic分析提示,前降支靶血管和年龄>65岁为术前cTnT<5倍URL患者介入术后无复流发生的独立危险因素;近段血管闭塞、年龄>65岁分别为术前cTnT为5~20倍URL组和术前cTnT>20 URL患者介入术后无复流的独立危险因素。结论急诊冠脉介入术前cTnT水平不同的STEMI患者,发生无复流的风险相当,但相关危险因素不同。Objective To explore impact of preoperative the high-sensitivity troponin T(cTnT)level on no-reflow phenomenon during the operation in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention.Methods Patients who received primary percutaneous coronary intervention due to acute STEMI in Zhongshan Hospital,Fudan University between January 2013 and February 2015 were retrospectively analyzed.A total of 677 patients were enrolled,who were devided into the preoperative cTnT<5 times the upper limit of normal reference(URL;5 URL group,n=337),5-20 times URL(5-20 URL)group(n=141),and cTnT>20 times URL(20 URL)group(n=199).The association between different levels of preoperative cTnT and no-reflow was analyzed,and multivariate logistic regression analysis was used to analyzed the independent risk factors for the occurrence of no-reflow at different levels of preoperative cTnT.Results The proportion of TIMI flow grade 0 or 1 at once after coronary stent implantation was 15.4%,19.1%,and 18.6%(P=0.499)in 5 URL group,5-20 URL group,and 20 URL group,respectively.Multivariate logistic analysis suggested that in the 5 URL group,target vessel of anterior descending branch and age>65 years were independent risk factors for the occurrence of no-reflow,while proximal vessel occlusion and>65 years old were independent risk factor for the occurrence of no-reflow in the 5-20 URL and 20 URL groups,respectively.Conclusions In STEMI patients with different preoperative cTnT levels,the risk of no-reflow is comparable,but the risk factors for predicting the occurrence of no-reflow were different.

关 键 词：急性心肌梗死 肌钙蛋白 急诊冠脉介入术 无复流 

分 类 号：R542.22[医药卫生—心血管疾病]