Objective To observe the clinical characteristics and angiographic features of spontaneous reperfusion(SR) in patients with acute ST-segment elevation myocardial infarction (STEMI); to explore the predictors of SR in infarct related artery (IRA); to evaluate the prognosis of the two groups. Method 206 patients with acute STEMI and received emergent percutaneous coronary intervention (PCI) were included. According to the results of coronary angiography (CAG), 56 patients of SR group were defined as the TIMI2-3 grade and 150 patients of NSR group were defined as TIMI 0-1 grade. The clinical features, angiographic features and prognosis of the two groups were analyzed for investigation of the predictors of SR. Result The ratio of pre-infarction angina, ECG down > 50% and IRA located in LAD in SR group were higher than that in NSR group (all P<0.05). Stressful hyperglycemia and myocardial bridge were lower (both P<0.05). The levels of preoperative chest pain relief score, onset-to-medical therapy time , CK, CK-MB, cTnl, Scr NLR and PLR in SR group were lower than in NSR group (all P<0.05). Results of multivariable logistic regression analysis showed that pre-infarction angina, onset-to-medical therapy time , ECG down more than 50%, NLR and PLR can be used as predictors of SR. The incidence of major adverse cardiovascular events (MACE) in the SR group was lower than that in the NSR group ( P<0.05), and the cardiac function in SR group is better than in NSR group (P<0.05) at three months later. Conclusion There were certain rate of SR in acute STEMI patients before PCI treatment. Pre-infarction angina, onset-to-medical therapy time, ECG down more than 50%, NLR and PLR can be used as predictors of SR. SR can reduce the incidence of MACE during hospitalization, and be beneficial to the prognosis of patients.%目的 观察急性ST段抬高型心肌梗死(STEMI)罪犯血管发生自发再灌注(SR)患者临床特征及造影特点;探讨梗死相关动脉(IRA)发生SR的预测因素;评价两组患者预后情况.方法 回顾性分析确诊为急性STEMI并急诊行经皮冠状动脉介入治疗(PCI)的206例患者,根据冠状动脉造影(CAG)结果,按照溶栓治疗临床试验血流分级,TIMI 2~3级定义为SR组56例,TIMI 0~1级定义为未自发再灌注(NSR)组150例;分析两组患者临床特征、造影特点及预后情况,探索自发再灌注预测因素.结果 SR组发生梗死前心绞痛、心电图(ECG)的ST段回落>50%、IRA位于冠状动脉前降支(LAD)的比率均高于NSR组(P<0.05),而发生应激性高血糖和存在肌桥比率低于NSR组(P<0.05);SR组术前胸痛缓解评分、发病到用药时间、肌酸磷酸酶(CK)、肌酸磷酸酶同工酶(CK-MB)、肌钙蛋白I (cTnl)、肌酐(Scr)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)水平均低于NSR组(P<0.05);多因素Logistic回归分析表明,梗死前心绞痛、发病到用药时间、ECG回落>50%、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)是发生自发再灌注的预测因素;SR组住院期间心血管不良事件(MACE)发生率低于NSR组(P<0.05),三个月后随访心脏功能优于NSR组(P<0.05).结论 急性STEMI行PCI治疗之前有一定的自发再灌注率;梗死前心绞痛、发病到用药时间、ECG回落>50%、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)可作为自发再灌注的预测因素;SR可减少住院期间主要心血管不良事件(MACE)发生,有益于患者预后.
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