Analysis On Risk Factors Of No-reflow Phenomenon In AMI Patients After CI

Objective：The primary goal of the treatment of acute myocardialinfarction(AMI) is to restore blood flow of infarct-related artery(IRA) and reducemyocardial ischemic injury. Percutaneous coronary intervention(PCI) which is the mosteffective method to treat AMI could directly open occluded coronary and restore normalblood flow.The no-reflow phenomenon could seriously affect clinical outcome of AMIpatients. Its etiology and pathogenesis is not yet fully clear. At present,there are nodrugs that can completely reverse the no-reflow.It is particularly important that makinguse of relevant clinical parameters to identify no-reflow phenomenon and prevent itsoccurrence.Methods: This study involved a total of310cases of inpatients that aredefinitely diagnosed as acute myocardial infarction（AMI）in Affiliated ZhongshanHospital of Dalian University from January2010to April2013.These patients allaccepted coronary stents treatment.According to the relevant inclusion and exclusioncriteria, a total of261cases of this clinical study were enrolled. In this study, it adoptscorrected TIMI frame count flow method (CTFC) to determine the no-reflowphenomenon. There were only39cases whose coronary angiography result after successful coronary intervention meets the diagnostic criteria of no-reflow, including25males and14females.The remaining222cases of patients were in normal blood group,including163cases were male, female59cases. Make use of relevant statisticalmethods to compare the no reflow group of patients with normal blood group on theaspects of patient’s sex, age, body mass index, smoking history, hypertension, diabetesmellitus, angina before infarction, reperfusion time, pulse pressure, infarction position, culprit vessel, stenosis degree, lesion counts, TIMI flow before PCI, collateralcirculation, so as to analyze statistical differences.Results:(1) This study shows that the incidence of no-reflow was14.9%.(2)Through comparison of basic clinical data between no-reflow and normal blood group,it can be found that there is no significant difference (P>0.05) in age[（63.4±13.9）years vs64.5±11.2years；P=0.539], smoking history（38.5%vs43.7%；P=0.543）,body mass index[（26.47±2.69)kg/m2vs (25.90±3.43)kg/m2；P=0.327], history ofhypertension（56.4%vs68.9%；P=0.125）. However, the two groups in the aspects assex（man）（64.1%vs73.4%；P=0.045）,history of diabetes（35.9%vs20.7%；P=0.038）, pre-infarction angina （12.8%vs34.2%；P <0.001）and reperfusion time[（7.1±3.8）h vs（4.9±2.3）h；p=0.026]have a significant difference (P<0.05).(3)Through comparison of laboratory results between no-reflow and normal blood group,it can be found that there is no significant difference (P>0.05) intriglycerides[（1.58±0.81）mmol/Lvs （1.80±0.96）mmol/L；P=0.191], low-densitylipoprotein cholesterol[（2.91±1.07）mmol/Lvs（2.75±0.95）mmol/L；P=0.342],uric acid[（340.38±106.42）umol/L vs（348.30±105.04）umol/L；P=0.665], bloodglucose[（7.34±4.11）mmol/l vs （7.22±3.33）mmol/l；P=0.835]. However, thetwo groups in the aspects as history of white blood cell count[（9.85±3.17）×109/L vs（6.76±2.18）×109/L；P=0.033], mean platelet volume[（10.6±1.1)fl vs (9.7±0.9)fl；P=0.012]and total cholesterol[（4.92±1.01）mmol/L vs （4.34±1.13）mmol/L；P=0.042]have a significant difference (P<0.05).(4) Through comparison of coronaryangiography data between no-reflow and normal blood group, it can be found that thereis no significant difference (P>0.05) in pulse pressure, infarction position, culpritvessel, stenosis degree[（95.3±2.2)%vs(93.8±3.1）%], lesion counts, TIMI flowbefore PCI（87.2%vs81.5%）. However, the two groups in the aspects as collateralcirculation have a significant difference (P<0.05).(5)Furthermore, multiple Logisticregression analysis indicated that history of diabetes (OR2.79;95%CI1.20-6.48),before non-infarction angina (OR2.24;95%CI1.32-6.47), reperfusion time (OR3.84;95%CI1.25-9.83), white blood cell count (OR1.22;95%CI1.03-3.69), mean platelet volume (OR1.87;95%CI1.16-5.23), no collateral circulation (OR1.13；95%CI0.96-2.84) are independent risk factors of no-reflow during primary PCI in AMI.Conclusion:(1) Age, sex, smoking history, body mass index, history ofhypertension, total cholesterol,, low-density lipoprotein sterols, triglycerides, uric acid,blood glucose,pulse pressure, infarction position, culprit vessel, stenosis degree,lesion counts and TIMI flow before PCI, these all have no significant correlation withthe no-reflow.(2) Time of reperfusion, history of diabetes, no pre-infarction angina,mean platelet volume,white blood cell count and no collateral circulation are theindependent risk factors of no-reflow phenomenon. Time of reperfusion is the mostrelevant factor with no-reflow phenomenon.(3) We can reduce no-reflow incidence byopening infarct-related artery timely.