女性急性心肌梗死患者急诊冠状动脉介入术后无复流发生的危险因素分析

摘要

目的 探讨女性急性心肌梗死患者在接受急诊PCI术后出现冠状动脉无复流的相关危险因素.方法 选择在复旦大学附属中山医院因急性ST段抬高型心肌梗死(STEMI)接受急诊PCI的女性患者178例,其中无复流组40例(TIMI 0～2级),正常血流组138例(TIMI 3级).比较2组患者临床特点、心脏超声、冠状动脉造影结果.结果 无复流组术后LVEF明显低于正常血流组[(50.4±9.4)％ vs (55.0±9.7)％,P=0.016],院内病死率明显高于正常血流组(12.5％ vs 3.6％,P=0.032).无复流组糖尿病、血管近段病变、多支病变和病变血管数明显高于正常血流纽,术后收缩压水平明显低于正常血流组,差异有统计学意义(P＜0.05).多因素logistic回归分析显示,血管近段病变(OR=2.177,95％CI:1.025～4.622,P=0.043)和病变血管数(OR=1.750,95％ CI:1.085～2.821,P=0.022)是急诊PCI术后无复流发生的独立相关因素.结论 急性心肌梗死急诊PCI术后发生无复流患者的预后较差.血管近段病变、病变血管数可能是女性患者发生无复流的独立预测因素.%Objective To study the risk factors for no-reflow in female acute ST segment elevation myocardial infarction (STEMI) patients after primary PCI.Methods One hundred and seventy-eight female acute STEMI patients admitted to our hospital from for primary PCI were divided into no-reflow (TIMI flow grade 0-2) group (n=40) and normal reflow (TIMI flow grade 3) group (n=138).Their clinical data,echocardiographic and coronary arteriographic findings were compared.Results The LVEF was significantly lower while the inhospital mortality was significantly higher in no-reflow group than in normal reflow group after primary PCI (50.4％ ± 9.4％ vs 55.0％±9.7％,P=0.016;2.5％ vs 3.6％,P=0.032).The incidence of diabetic mellitus,lesion of proximal blood vessel and multiple vessels was significantly higher and the number of lesioned blood vessels was significantly greater while the SBP was significantly lower in no-reflow group than in normal reflow group after primary PCI (P＜0.05).Multivariate logistic regression analysis showed that the lesion of proximal blood vessels and the number of lesioned blood vessels were the independent risk factors for no-reflow in female acute STEMI patients after primary PCI (OR=2.177,95％CI:1.025-4.622,P=0.043;OR=1.750,95％CI:1.085-2.821,P=0.022).Conclusion The prognosis is poor in female acute STEMI patients with no-reflow after primary PCI.The lesion of proximal blood vessels and the number of lesioned blood vessels are the independent risk factors for no-reflow in female acute STEMI patients after primary PCI.