Objective To analyze risk factors of no-reflow phenomenon in patients with acute ST-elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention (PPCI).Methods Totally 332 STEMI patients who had PPCI from January 2007 to January 2010 in Beijing Anzhen Hospital,Capital Medical University were divided into 2 groups according to thrombolysis in myocardial infarction(TIMI) coronary flow grade after PPCI:no-reflow group(30 cases,TIMI grade 0-2) and control group(302 cases,TIMI grade 3).Totally 39clinical items were recorded,including age,sex,angina history,myocardial infarction history,hypertension history,diabetes history,smoking history,PCI history,β-receptor antagonist usage,myocardial infarction site,single vessel/multiple vessels lesion,culprit vessel site,culprit vessel occlusion degree,occurrences of preoperative primary ventricular fibrillation,intraoperative ventricular fibrillation,preoperative ventricular tachycardia,intraoperative ventricular tachycardia,preoperative bradycardia,introperative bradycardia,introperative hypotension,the usage of thrombus suction device during operation,the usage of intra-aortic balloon counterpulsation during operation,the usage of temporary pacemaker during operation,the length between myocardial infarction and PPCI,ejection fraction,high-density lipoprotein,low-density lipoprotein,triacylglycerol,cholesterol,glycosylated hemoglobin,fibrinogen,urea,uric acid,creatinine,blood potassium,blood glucose,white blood cell count,neutrophil percentage and hemoglobin level.Multivariate logistic regression was used to analyze risk factors of no-reflow phenomenon after PPCI.Results In present study,the incidence of no-reflow phenomenon was 9.0％(30/332).Age,the ratio of culprit vessel total occlusion,the ratio of introperative bradycardia,high density lipoprotein level,fibrinogen level and neutrophil percentage had significant differences between no-reflow group and control group[(61 ± 11) years vs (57 ± 11) years,83.3％ (25/30) vs 62.9％ (190/302),46.7％ (14/30) vs 25.8％(78/302),(0.98 ± 0.18) mmol/L vs (1.05 ±0.27)mmol/L,(2.8±0.9)g/L vs (2.5±0.7)g/L,(78 ± 14) ％ vs (73 ± 15) ％] (P ＜ 0.10).Multivariate logistic stepwise regression showed that intraoperative bradycardia(odd ratio =3.392,95％ confidence interval:1.427-8.062,P =0.006) and high fibrinogen level (odd ratio =2.017,95％ confidence interval:1.167-3.487,P =0.012) were independent risk factors of no-reflow phenomenon after PPCI.Conclusion Intraoperative bradvcardia and high fibrinogen level are independent risk factors of no-reflow phenomenon after PPCI in acute STEMI patients.%目的 探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入(PPCI)术后发生无复流的危险因素.方法 选取2007年1月至2010年1月首都医科大学附属北京安贞医院连续收治的行PPCI术的STEMI患者332例,术后行冠状动脉造影,根据梗死相关动脉前向血流的心肌梗死溶栓试验(TIMI)血流分级分为无复流组(30例,TIMI 0 ～2级)和对照组(302例,TIMI 3级).记录所有患者的临床资料,包括年龄、性别、心绞痛史、心肌梗死史、高血压史、糖尿病史、吸炯史、经皮冠状动脉介入史、入院前是否服用β受体阻滞剂、心肌梗死位置、单/多支血管病变、罪犯血管位置、罪犯血管闭塞程度、术前发生原发性心室颤动、术中发生心室颤动、术前发生室性心动过速、术中发生室性心动过速、术前发生心动过缓、术中发生心动过缓、术中发生血压下降、术中使用血栓抽吸装置、术中使用主动脉内球囊反搏、术中使用临时起搏器、发生心肌梗死距PPCI的时间、射血分数、高密度脂蛋白、低密度脂蛋白、三酰甘油、胆固醇、糖化血红蛋白、纤维蛋白原、尿素、尿酸、肌酐、血钾、血糖、白细胞计数、中性粒细胞百分比及血红蛋白水平,共39项.采用多因素Logistic逐步回归分析急性STEMI患者PPCI术后发生无复流的危险因素.结果 本研究中无复流现象的发生率为9.0％(30/332).无复流组与对照组患者的年龄、罪犯血管完全闭塞、术中发生心动过缓、高密度脂蛋白、纤维蛋白原及中性粒细胞百分比之间差异有统计学意义[(61±11)岁比(57±1 1)岁,83.3％(25/30)比62.9％(190/302),46.7％ (14/30)比25.8％ (78/302),(0.98±0.18) mmol/L比(1.05±0.27) mmol/L,(2.8±0.9) g/L比(2.5±0.7) g/L,(78±14)％比(73±15)％](P＜0.10);多因素Logistic逐步回归分析显示术中发生心动过缓(比值比=3.392,95％置信区间:1.427～8.062,P=0.006)和纤维蛋白原(比值比=2.017,95％置信区间:1.167 ～ 3.487,P=0.012)可作为预测PPCI术后发生无复流的独立危险因素.结论 术中发生心动过缓和纤维蛋白原水平高是急性STEMI患者PPCI术后发生无复流的独立危险因素.
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