Analysis Of Factors Influencing Emergency PCI Flow Grade In STEMI Patients

Objective:To study the blood flow classification of emergency PCI in STEMI patients,analyze the factors of no-reflow in emergency PCI in STEMI patients,and build a risk nomogram model in order to provide reference for clinical identification of high-risk patients without reflow.Methods:In this study,retrospective analysis was adopted,and the patients with STEMI who were treated in our hospital from January 2021 to December 2021 and underwent PCI were selected as the research objects.Finally,400 patients met the inclusion and exclusion criteria,including 254 male patients and 146 female patients,aged between 36and 85,with an average age of 61.87±6.98 years.All the included patients underwent coronary angiography and at least.After PCI,the patients were taken angiography again to judge the TIMI grade of the patients’arteries.Among them,TIMI≤1 grade was considered as no reflow,while TIMI≤2 grade was called slow reflow.In this study,all TIMI≤2 grades were included in the no-reflow/slow reflow group,and the rest were normal blood flow group.Baseline data and past medical history of patients are obtained by consulting patients’cases,in which the baseline data includes patients’age and sex ratio,and the past medical history includes diabetes history,hypertension history,drinking history,smoking history,stroke history,hyperlipidemia history,the time of door-to-ballon.Venous blood was collected from all patients on the morning after admission,that is,fasting for more than 8 hours,and sent to the laboratory for testing.The indicators were mainly blood routine and biochemical indicators.The blood routine includes neutrophil value(N),lymphocyte value(L),white blood cell(WBC),neutrophil/lymphocyte ratio(N/L),platelet(PLT),platelet distribution(PDW),mean platelet volume(MPV)and fasting blood glucose(FBG),and biochemical indicators include low density lipoprotein(LDL).SPSS25.0 was used for statistical processing,and the data were tested for normality.The measured data of normal distribution were expressed as mean standard deviation,and the comparison between groups was made by two independent samples’T test,and the counting data was expressed as percentage.The comparison between groups was made by X2 test.If the theoretical frequency was less than 5,Fisher’s exact probability method was used for comparison,and multivariate Logistic analysis was used to analyze the risk factors of no-reflow in STEMI patients after emergency PCI.Score according to the value of each risk factor,and build a nomogram prediction model.The consistency index(C-index)was calculated by R(R3.5.3)software package and rms software package,and the calibration curve and receiver operating characteristic(ROC)curve were drawn to evaluate the prediction efficiency of the model.The accuracy of the model was evaluated by Decision curve analysis(DCA).Results:(1)A total of 400 eligible patients were included in this study.After treatment,the follow-up results showed that there were 36 patients with no reflow or slow blood flow,and 364 patients with normal blood flow.The general data of the two groups were compared,including gender ratio,age,history of hypertension,history of diabetes,history of hyperlipidemia,history of stroke,history of drinking and history of smoking,and the time of door-to-ballon.The results showed that there was no significant difference between the two groups(P>0.05).(2)The levels of neutrophil(N),neutrophil/lymphocyte ratio and white blood cells(WBC)in the no-reflow group were significantly higher than those in the normal blood flow group(P<0.05),but the lymphocyte value(L),platelet(PLT),platelet distribution(PDW)and mean platelet volume(MPV)of the two groups were significantly higher.(3)The levels of low-density lipoprotein(LDL),fasting blood glucose(FBG)andγ-glutamyltranspeptidase(γ-GGT)(U/L)in the no-reflow group were significantly higher than those in the normal blood flow group(P<0.05),while the total cholesterol(TC),high-density lipoprotein(HDL),triglyceride(TG)and C-reactive protein(CRP)in the two groups were significantly higher.(4)The proportion of thrombus aspiration and aortic balloon counterpulsation were significantly higher than those in normal blood flow group,with statistical significance(P<0.05),but there were no statistical differences in the proportion of antithrombotic drugs used,the proportion of complicated conduction block and the proportion of multi-vessel lesions(P>0.05).(5)Multivariate Logistic analysis showed that,Neutrophil value(N)≥12.13(×10~9/L),neutrophil/lymphocyte ratio(N/L)≥12.95,white blood cell(WBC)≥13.12(×10~9/L),fasting blood glucose(FBG)≥7.25(mmol/L),low density lipoprotein(LDL)≥3.24(mmol/L),Aortic balloon counterpulsation are all independent risk factors of no reflow/slow flow after emergency PCI in STEMI patients(P<0.05).(6)according to the value of each risk factor,Neutrophil value(N)≥12.13(×10~9/L)gives19 points,neutrophil/lymphocyte ratio(N/L)≥12.95 gives 24 points,white blood cell(WBC≥13.12(×10~9/L)gives 13 points,and fasting blood glucose(FBG)≥7.25 gives 38points,low density lipoprotein(LDL)≥3.24(mmol/L)gives 45 points,Gamma-glutamyltranspeptidase(γ-GGT)(U/L)≥45.34 was given 60 points,thrombus aspiration was given 10 points,aortic balloon counterpulsation was given 31 points,and the total score was 240 points.The nomogram prediction model was constructed,and the Bootstrap method was used to verify the nomogram prediction model internally.The results show that the C-index of the training set and the verification set are 0.823(95%CI:0.822～0.934)and 0.823(95%CI:0.819～0.889)respectively.The calibration curves of both episodes fit well with the ideal curves.The AUC of ROC in the two episodes were0.893(95%CI:0.802～0.934)and 0.867(95%CI:0.823～0.908)respectively.The DCA curve of nomogram prediction model shows that when the threshold probability is1%～90%,the net benefit rate is>0.All the above results show that the prediction model has high accuracy,good effectiveness,safety and reliability,and strong practicability.(7)Conclusion:Neutrophil value(N)≥12.13(×10~9/L),neutrophil/lymphocyte ratio(N/L)≥12.95,white blood STEMI(WBC)≥13.12(×10~9/L),fasting blood glucose(FBG)≥7.25,low density lipoprotein(LDL)(mmol/L)≥3.24、Gamma-glutamyltranspeptidase(γ-GGT)(U/L)≥45.34、Aortic balloon counterpulsation are all independent risk factors of no reflow/slow flow after emergency PCI in STEMI patients.Based on this,the nomogram prediction model is constructed,which has high value in predicting the occurrence of no reflow/slow flow after emergency PCI in STEMI patients.