急性冠状动脉综合征患者经皮冠状动脉介入术后无复流现象的危险因素及预后Risk factors and prognosis of no-reflow phenomenon in patients with acute coronary syndrome after PCI
丛洪良,张梅,王伟,陈树涛,徐延敏,周长钰,李广平,黄体钢
摘要(Abstract)：
目的分析经皮冠状动脉介入治疗(PCI)后冠状动脉无复流现象发生的危险因素和预后。方法回顾性分析因急性冠状动脉综合征入我院行PCI治疗的患者524例中有较完整随访资料的427例,PCI支架置入即刻在无影响血流的血栓、栓塞、夹层、痉挛情况下,冠状动脉造影前向血流TIMI≤2级为无复流,TIMI 3级为正常血流。利用Excel随机函数表,从393例急诊PCI冠状动脉前向血流恢复正常的患者中随机抽取70例,为对照组。结果冠状动脉无复流患者34例,无复流组心肌梗死和糖尿病比例明显高于对照组,且胰岛素水平、白细胞总数和中性粒细胞总数也明显高于对照组。院内和院外不良事件发生率无复流组明显高于对照组,左心室射血分数较前明显减低,而左心室舒张末内径较前明显增大。结论无复流受既往糖尿病、胰岛素及白细胞水平的影响,可使住院期间和院外不良事件明显增加,是心肌继续缺血、心室重构和心功能恢复障碍的预测因子,也是心肌和微血管损伤的标志。
关键词(KeyWords)： 血管成形术,经腔,经皮冠状动脉;急性冠状动脉综合征;预后
基金项目(Foundation):
作者(Author): 丛洪良,张梅,王伟,陈树涛,徐延敏,周长钰,李广平,黄体钢
参考文献(References)：
- [1]Resnic FS,Wainstein M,Lee MK,et al.No-reflow is an indepen-dent predictor of death and myocardial infarction after percutaneouscoronary intervention.Am Heart J,2003,145:9-11.
- [2]Gin S,Mitchel J F,Hirst JA,et al.Synergy between intracoronarystenting and abciximab in improving angiographic and clinical out-comes of primary angioplasty in acute myocardial infarction.Am JCardial,2000,86:269-274.
- [3]Wainstein M,Frederic F,Lee M,et al.Lack of clinical efficacy ofpharmacologic treatment of the no-reflow phenomenon despite signifi-cant angiographic improvement.J Am Coll Cardiol,2001,37:83-86.
- [4]Iwakura K,Ito H,Ikushima M,et al.Association between hypergly-cemia and the no-reflow phenomenon in patients with acute myocardialinfarction.J Am Coll Cardiol,2003,41:1-7.
- [5]Kojima S,Sakamoto T,Ishihara M.The white blood cell count is anindependent predictor of no-reflow and mortality following acute myo-cardial infarction in the coronary interventional era.Ann Med,2004,36:153-160.
- [6]Morishima I,Sone T,Okumura K,et al.Aniographic no-reflow phe-nomenon as a predictor of adverse long term outcome in patients treat-ed with percutaneous transluminal coronary angioplasty for first acutemyocardial infarction.J Am Coll Cardiol,2000,36:1202-1209.