Objective:No reflow of coronary is a serious complication after PCI in patients with ST segment elevation myocardial infarction(STEMI),and is closely related to major adverse cardiovascular events(MACE).This study collected relevant data on STEMI patients treated with direct PCI and conducted a 10-year long-term follow-up,to study the clinical characteristics and long-term MACE of patients with no reflow.Methods:A retrospective analysis was conducted on 914 patients who underwent chest pain within 12 hours of onset at Beijing Anzhen Hospital from January 2010 to January 2013.All patients were diagnosed with STEMI and received direct PCI treatment,and were hospitalized in the cardiology department to complete relevant examinations.Among them,40 patients did not meet the standards,and the final number of patients included in the analysis was 874.Relevant medical data of the above patients were collected and followed up for 10 years to collect long-term MACE data.According to whether there is no reflow,the two groups were divided into a non reflow group(183 cases)and a normal reflow group(691 cases).The differences in basic clinical data,laboratory indicators,coronary angiography indicators,and long-term MACE between the two groups were analyzed.Results:The basic data showed that the proportion of no reflow group combination with type 2 diabetes[63(34.4％)vs.171(24.7％),P=0.009],heart rate[(82±18)vs.(76±14)times/min,P＜0.001],Killip grade＞Ⅰ[148(80.9％)vs.507(73.4％),P=0.037],EF＜35％[26(14.2％)vs.35(5.1％),P＜0.001],ventricular aneurysm[15(8.2％)vs.30(4.3％),P=0.036]were significantly higher than that of normal reflow group,and the total number of white blood cells[(12.2±3.5)vs.(10.6±3.2)x 109/L,P＜0.001],neutrophil count[(10.0±3.3)vs.(8.1±3.2)x 109/L,P＜0.001],random blood glucose[(10.1±5.5)vs.(8.1±4.9)mmol/L,P＜0.001],hs-CRP[9.5(3.8,18.6)vs.7.1(2.9,13.6)mg/L,P=0.002],LDL-C[(3.2±0.8)vs.(3.1±0.7)mmol/L,P=0.019]levels were significantly higher than those in the normal reflow group,and lymphocyte count[1.4(1.0,1.9)vs.1.6(1.2,2.2)x 109/L,P=0.027]lower than the normal reflow group;Coronary artery angiography indicators showed that the proportion of multi vessel lesions in the no reflow group[99(49.2％)vs.150(21.7％),P＜0.001]was significantly higher than that in the normal reflow group.During surgery,glycoprotein Ⅱ b/Ⅲ a inhibitors were used[137(74.9％)vs.138(20.0％),P＜0.001],and intra aortic balloon counterpulsation(IABP)was used[44(24.0％)vs.43(6.2％),P＜0.001],the thrombus aspiration surgery[143(78.1％)vs.329(47.6％),P＜0.001]was significantly higher than that of the normal reflow group;A 10-year long-term follow-up showed that the cumulative cardiovascular risk in the no reflow group was significantly higher than that in the normal reflow group(P＜0.001),and the cumulative survival rate was significantly lower than that in the normal reflow group(P＜0.001).Conclusion:Patients with STEMI experience a significant increase in long-term cumulative cardiovascular risk and a significant decrease in survival rate after no reflow of coronary.No reflow of coronary significantly affects the long-term prognosis of patients.
关键词
ST段抬高型心肌梗死/无复流/主要不良心血管事件
Key words
ST segment elevation myocardial infarction/No reflow/Major adverse cardiovascular events
维普
万方数据