The Discussion Of Relevant Factors Led To The Occurrence Of No-reflow Phenomenon In Emergency PCI Of Acute Myocardial Infarction

Acute myocardial infarction is one of the serious clinical diseases , which can lead to patients with cardiac arrest and even sudden death easily. In recent years, the morbidity and mortality of ami in our country is to show increasing trend year by year,which is a serious threat to human health. AMI is acute coronary thrombosis occlusion which is caused by the coronary atherosclerotic plaque rupture .it makes blood supply to myocardial tissue to reduce and myocardial necrosis to happen. The key to cure AMI is to open infarct-related artery as soon as possible and restore blood flow, to save the dying myocardial. At present, percutaneous coronary intervention (PCI) is the most effective method of treatment AMI, which can rapid recovery blood perfusion of ischemic myocardium, save the dying myocardium, improve cardiac function and reduce mortality. However, a number of clinical trials discovered that some patients with AMI experienced thrombolysis and (or) recanalization after angioplasty of coronary infarction,but the survival rate did not significantly improve, epicardial coronary blood flow patency did not mean that the level of myocardial reperfusion has been fully restored, the microcirculation is still blocking so that the lack of effective myocardial perfusion, expressed as no-reflow phenomenon.Still 10-30% of the patients with acute myocardial infarction after PCI existed a no-reflow phenomenon, blood perfusion did not fully achieved the level of myocardial tissue, the incidence and died rate of the patient re-infarction, congestive heart failure, cardiac malignant case also increased significantly, which impacted on short-term prognosis of patients seriously. Therefore, the study of the relevant factors of no-reflow has become the key to treatment, which could clear the relevant factorss in the future treatment of AMI.Objective: To study the relevant factors of no-reflow phenomenon occurred in the acute myocardial infarction in emergency percutaneous coronary intervention treatment.Methods: 492 cases patients with AMI who accepted the emergency PCI were choosed for the study and think infarct-related artery blood flow prior to the TIMI≤2 level as the no-reflow phenomenon standards, patients were divided into no-reflow group and the normal blood flow group, in which forty-one cases happened without -reflow phenomenon,two cases were excluded because of the lack of the clinical and imaging data , thirty-nine cases were selected, and the remaining patients were randomly select fifty cases for the normal blood flow. The two groups were observed in patients with sex, age, smoking history, diabetes, high blood cholesterol, high blood pressure, family history of coronary heart disease, history of pre-infarction angina, compare both the number of Q waves, infarction location, heart function classification, surgery and coronary angiography balloon morphological changes.Results: 492 cases in the study, thirty-nine cases patients happened the no-reflow, the occurrence rate was 7.93%. No-reflow group and the blood flow in the normal group had no significant difference in age, sex, smoking history, hypertension, family history of coronary heart disease, infarction, balloon inflation pressure, balloon diameter,the degree of infarct artery stenosis, multivessel disease, reference vessel diameter, site of infarction(P> 0.05),but had significant difference in diabetes, hyperlipidemia, history of pre- infarction angina, Q-wave number the number of balloon dilatation, blood vessel total occlusion, and cardiac function in calcification Killip classification scale≥2 (P <0.05).Discussion: AMI threats to human health and life, emergency PCI can be effective to open occluded blood vessels in the shortest possible time, restorate myocardial perfusion, save myocardial salvage dying, but clinical research showed that after emergency PCI, there were still 10 - 30% of patients existed no-reflow phenomenon, blood perfusion was not fully achieved the level of myocardial tissue, the incidence and case fatality rate of patients with malignant heart increased significantly. Therefore, to improve myocardial microcirculation reperfusion and reduce no-reflow phenomenon in the incidence of treatment of AMI has become the new hot spot.the mechanism of No-reflow are complex and do not yet clear entirely, but studies have shown that it had related to endothelial cells with swelling, microvascular plugging, microvascular spasm, micro- thrombosis and leukocyte aggregation, adhesion and so on.the happening of no-reflow has many relevant factors, the results of this study indicate that the occurrence of no-reflow has relation with diabetes, high blood lipids, pre-infarction angina, Q-wave number, frequency of intraoperative balloon dilatation, blood vessel total occlusion, calcification and it can reduce the occurrence of no-reflow effectively if we treat the related factors before preoperative and intraoperative.Conclusion: No-reflow phenomenon has no correlation with age, sex, smoking history, hypertension, family history of coronary heart disease, infarction, balloon inflation pressure, balloon diameter, the degree of vascular stenosis, multivessel disease, reference vessel diameter and infarction,but has relevance with diabetes, high blood lipids, pre-infarction history of angina, Q-wave number , the number of balloon dilatation, blood vessel total occlusion, calcification and cardiac function.