Analysis Of The Factors Related To No-reflow In Patients With Acute ST-Segment Elevation Myocardial Infarction During Primary PCI

Background and objective:Acute ST-segment elevation myocardial infarction(STEMI)is a kind of cardiovascular disease with acute onset,severe harm,high mortality and poor prognosis,the primary percutaneous coronary intervention(PCI)is recognized as the preferred treatment for acute STEMI.However,in patients receiving primary PCI therapy,the no-reflow phenomenon often occurs.The reason and mechanism of the occurrence of no-reflow is not yet very clear at present,some scholars have put forward some hypotheses,but there is no unified theory at home and abroad,and there is no systematic and perfect control strategy in clinical practice.No-reflow is closely related to the prognosis of the patients.For clinicians,it is of great significance to change the research focus on no-reflowfrom treatment to effective methods of prevention.Therefore,this research is based on the Corrected TIMI Frame Count(CTFC)as an indexof no-reflow In patients with acute STEMI,aiming to analyze the primary PCI in no-reflow related factors,and the effect of no-reflow on short-term prognosis,and to investigate its mechanism,thus providing a theoretical basis for the clinical prevention and control.Methods:From October 2015 to December 2016 in the cardiac emergency department of the First Affiliated Hospital of Dalian Medical University,461 cases diagnosed as acute STEMI were continuously selected,including 312 males,149 females,all of whom received primary PCI within 12h of disease onset in the cardiac catheterization laboratory via emergency medical servicefrom the chest pain center.According to TIMI blood flow classification and CTFC,the patients were divided into no-reflow group and normal blood flow group,no-reflow group was 68 cases(n=68),normal blood flow group was 393 cases(n=393).The baseline data,clinical data,test results,coronary angiographic data and PCI data were compared between the two groups,and the factors related to the occurrence of no-reflow during primary PCI in patients with acute STEMI were analyzed.At the same time,the incidence of major adverse cardiovascular events during hospitalization was recorded in the two groups,and the effect of no-reflow on the short-term prognosis of patients with acute STEMI was investigated.Results:1.From October 2015 to December 2016,a total of 461 patients with acute STEMI received primary PCI in the First Affiliated Hospital of Dalian Medical University,of these 68 patients were no-reflow cases during PCI,an incidence of 14.8%.2.In this study 46 indices were analyzed,single factor analysis showed that for the no-reflow group and the normal blood flow group:gender,smoking history,history of hypertension,dyslipidemia history,family history of coronary heart disease,history of myocardial infarction,previous history of PCI,primary PCI preoperative systolic blood pressure,diastolic blood pressure,heart rate,serum creatinine,uric acid,blood potassium,D-dimer,B-type natriuretic peptide,hemoglobin count,white blood cell count,platelet count,fasting blood glucose,high-sensitivity C-reactive protein,total cholesterol level,triglyceride,HDL-C,apolipoprotein A,apolipoprotein B,albumin,ALT,AST,surgical approach,intraoperative anticoagulation,presence of temporary pacemaker,the infarct related artery(IRA),the number of coronary artery lesions and lesion diameters,number of stents,use of simultaneous treatment for non-infarct related artery(non-IRA),etc.There are nostatistical significant differences(P>0.05).In those two groups,age,history of diabetes,ischemia time,Killip classification,homocysteine,LDL-C,the total length of stents,use ofpoststenotic dilation,TIMI flow gradebefore the intervention,presence of high thrombus burden,etc.,were also included.The statistical difference was significant(P<0.05).3.The multivariate logistic regression model suggested that the ischemia time(OR=1.156,95%CI 1.051-1.273,P=0.003),homocysteine(OR=1.321,95%CI,1.172-1.489,P=0.006),low TIMI flow grade before PCI(OR=0.382,95%CI,0.148-0.987,P=0.047),high thrombus burden(OR=3.260,95%CI 1.188-8.946,P=0.022)were independent risk factors for the occurrence of no-reflow in acute STEMI patients during primary PCI.4.In observation of major adverse cardiovascular events during hospitalization of the two groups of patients,the incidence of no-reflow in patients with malignant arrhythmia,heart failure,severe refractory angina,cardiac death and the composite-endpoint-event rates were higher than the normal flow group,and the difference was statistically significant(P<0.05).Conclusion:1.In acute STEMI patients,no-reflow during primary PCI is caused by multiple factors,including age,history of diabetes,ischemia time,Killip grade,homocysteine,LDL-C,the total length of stents,use ofpoststenotic dilation,TIMI flow gradebefore intervention,presence of high thrombus burden and other factors associated with no-reflow.2.Ischemic time,homocysteine,low TIMI blood flow grade before intervention and high thrombus load were independent risk factors to the occurrence of no-reflow in patients with acute STEMI during primary PCI.3.The no-reflow phenomenon,in addition to disease and individual factors,may also be associated with PCI treatment strategies and intervention-related vascular endothelial injury.Therefore,a standardized and reasonable treatment strategy can reduce the vascular endothelial "secondary damage" caused by surgery,so as to reduce the incidence of no-reflow.4.Compared with the normal blood flow group,the incidence of major adverse cardiovascular events in patients with no-reflow group was significantly increased,and the short-term prognosis was significantly worse.