马娟,马盛宗,严宁,贾绍斌

• 1:宁夏医科大学总医院(宁夏医科大学临床医学院)心内科

摘要(Abstract)：

目的 探讨入院休克指数对急性ST段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）术中冠状动脉无复流现象的影响。方法 采用回顾性横断面分析，选取2017年1月至2019年10月首次就诊于宁夏医科大学总医院心内科并行直接PCI术的641例STEMI患者，根据PCI术中血管造影结果，将入组患者分为无复流组和完全灌注组，对比分析两组心血管病危险因素、血液学指标及血管造影基线数据，并利用多因素Logistic回归分析模型评估休克指数与无复流是否相关，绘制受试者工作特征（ROC）曲线评价其预测价值。结果 641例患者分为无复流组104例与完全灌注组537例。多因素Logistic回归分析显示，休克指数（OR 4.740,95%CI 1.078～20.849,P=0.039）、血肌酐（OR 1.013,95%CI 1.003～1.023,P=0.007）、入院收缩压（OR 0.967,95%CI 0.936～0.988,P=0.036）是STEMI患者直接PCI术后发生冠状动脉无复流的危险因素。纳入完全灌注组与无复流组的休克指数进行ROC曲线分析，结果显示，休克指数预测冠状动脉无复流的曲线下面积为0.635(95%CI 0.577～0.692,P<0.001)，灵敏度为76.0%，特异度为56.5%，具有一定的预测价值。结论 入院休克指数≥0.635可能是STEMI患者直接PCI术中冠状动脉无复流的危险因素，对预测患者PCI术中冠状动脉无复流具有一定价值。

关键词(KeyWords)： 休克指数;急性心肌梗死;经皮冠状动脉介入治疗;无复流

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 马娟,马盛宗,严宁,贾绍斌

参考文献(References)：

• [1] Yanamala CM, Bundhun PK, Ahmed A. Comparing mortality between fibrinolysis and primary percutaneous coronary intervention in patients with acute myocardial infarction:a systematic review and meta-analysis of 27 randomizedcontrolled trials including 11 429 patients[J]. Coron Artery Dis, 2017,28(4):315-325.
• [2] Ishida K, Geshi T, Nakano A, et al. Beneficial effects of statin treatment on coronary microvascular dysfunction and left ventricular remodeling in patients with acute myocardial infarction[J]. Int J Cardiol,2012,155(3):442-447.
• [3] Thomas MP, Bates ER. Update on primary PCI for patients with STEMI[J]. Trends Cardiovasc Med,2017,27(2):95-102.
• [4]曾令泽，陈媛，吴胤松，等.急性冠状动脉综合征患者PCI术后冠脉无复流机制及治疗进展[J].中国循证心血管医学杂志，2021,13(9):1148-1149.
• [5] Ito H. Etiology and clinical implications of microvascular dysfunction in patients with acute myocardial infarction[J].Int Heart J,2014,55(3):185-189.
• [6]李勇.急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入术后发生无复流的危险因素[J].中国医药，2016,11(9):1269-1273.
• [7] Zhou FZ, Song W, Yin LH,et al. Ef fects of remote ischemic preconditioning on myocardial injury and endothelial function and prognosis after percutaneous coronary intervention in patients with acute coronary syndrome[J]. Eur Rev Med Pharmacol Sci, 2017,21(20):4642-4648.
• [8] Wang K, Zhang J, Zhang N,et al. Combined primary PCI with multiple thrombus burden reduction therapy improved cardiac function in patients with acute anterior myocardial infarction[J].Int Heart J, 2019,60(1):27-36.
• [9] Watanabe Y, Sakakura K, Taniguchi Y,et al.Determinants of slow fl ow in percutaneous coronary intervention to the culprit lesion of non-ST elevation myocardial infarction[J]. Int Heart J,2018,59(6):1237-1245.
• [10] Ren FX,Mu N,Zhang X, et al. Increased platelet-leukocyte aggregates are associated with myocardial no-refl ow in patients with ST elevation myocardial infarction[J]. Am J Med Sci,2016,352(3):261-266.
• [11] Zhang X,Wang Z,Wang Z,et al. The prognostic value of shock index for the outcomes of acute myocardial infarction patients:a systematic review and meta-a-nlysis[J].Medicine,2017,96(38):e8014.
• [12] El-Menyar A,Abdelrahman H,Alhammoud A,et al.Prognostic role of shock index in traumatic pelvic fracture:a retrospective analysis[J]. J Surg Res,2019,243:410-418.
• [13] Ibanez B, James S,Agewall S,et al. 2017 ESC guide lines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J,2018,39(2):119-177.
• [14] Durante A, Camici PG. Nove insights into an old phenomenon:the no refl ow[J]. Int J Cardiol, 2015,187:273-280.
• [15] Bahrehmand M, Sadeghi E, Shafiee A, et al. Predictors of delayed and no reflow as recognized with thrombolysis in myocardial lnfarction[TIMI]flow grade following primary percutaneous coronary angioplasty[J].Med Life, 2015, 8(Spec Iss 3):59-65.
• [16] Leyva F,Zegard A,Qiu T,et al. Cardiac resynchronization therapy using quadripolar versus non-quadripolar leftventricular leads programmed to biventricular pacing with single-site left ventricular pacing:impact on survival and heart failure hospitalization[J]. J Am Heart Assoc,2017,6(10):e007026.
• [17]谭远远，董淑娟，李静超，等. ST段抬高型心肌梗死直接经皮冠状动脉介入术治疗预后危险因素及危险分层[J].中华实用诊断与治疗杂志，2019,33(3):228-231.
• [18] Daneshsani SH,Eshraghi A,Shahri B,et al. No-reflow phenomenon in patients with st-elevation acute myocardial infarction,treated with primary percutaneous coronaryintervention:a study of predictive factors[J].J CardioThoracic Medicine,2014,2(4):221-226.
• [19] Shang X, Lu R, Liu M,et al. Heart rate and outcomes in patients with heart failure with preserved ejection fraction[J].Medicine(Baltimore),2017,96(43):e8431.
• [20] Garadah TS, Thani KB, Sulibech L,et al. Risk stratifi cation and in hospital morality in patients presenting with acute coronary syndrome(ACS)in Bahrain[J]. Open Cardiovasc Med J,2018,12:7-17.
• [21] Fajar JK, Heriansyah T, Rohman MS.The predictors of no reflow phenomenon after percutaneous coronary intervention in patients with ST elevation myocardial infarction:a metaanalysis[J]. Indian Heart J,2018,7 0(Suppl 3):S406-S418.
• [22] Zhou H, He XY, Zhuang SW,et al.Clinical and procedural predictors of no-refl ow in patients with acute myocardial infarction after primary percutaneous coronary intervention[J]. World J Emerg Med,2014,5(2):96-102.
• [23] Park JS, Cha KS, Shin D,et al.Prognostic significance of presenting blood pressure in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention[J]. Am J Hypertens,2015,28(6):797-805.
• [24] Reinstadler SJ, Fuernau G, Eitel C, et al.Shock index as a predictor of myocardial damage and clinical outcome in STelevation myocardial infarction[J]. Circ J,2016,80(4):924-930.
• [25]安福望，原艺萌．SI和MSI在急性非ST段抬高型心肌梗死患者预后评估中的价值[J].中国循证心血管医学杂志，2018,10(5):100-103.
• [26]王山，张优，高传玉，等.休克指数对急性ST段抬高型心肌梗死患者院内死亡的预测价值[J].中华实用诊断与治疗杂志，2019,33(9):849-852.
• [27] Wang G, Wang R, Liu L, et al. Comparison of shock indexbased risk indices for predicting in-hospital outcomes in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention[J]. J Int Med Res,2021,49(3):3000605211000506.
• [28] Shiraishi J, Kohno Y, Sawada T, et al. Prognostic impact of systolic blood pressure at admission on in-hospital outcome after primary percutaneous coronary intervention for acute myocardial infarction[J]. J Cardiol,2012, 60(2):139-144.
• [29] Dobre D, Kjekshus J, Rossignol P, et al. Heart rate, pulse pressure and mortality in patients with myocardial infarction complicated by heart failure[J]. Int J Cardiol,2018,271:181-185.