The Effect Of Platelet-lymphocytic Aggregation In Postconditioning To Reduce Myocardial No-reflow In Patients With STEMI

Objective:To observe the role of plateletlymphocytic aggregation in myocardial noreflow(MNR)who undergone the emergency department after interventional with S Tsegment elevation myocardial infarction(STEMI)patients,and to further study ischemic postconditioning(IPost C)impact on the circulating levels of PlyA.Methods:(1)93 cases diagnosed with STEMI for the first time and undergone emer gence percutaneous coronary intervention(PCI)visited the affiliated Yantai Yuhuang ding Hospital of Qingdao University were included in this study.At the same time,50 control subjects were recruited.All were given detection of the levels of Ply A with flow cytometry and differences were compared and analyzed within this 2 groups.(2)93 patients with STEMI were randomly assigned into two groups:IPost C group and normal operation group.In IPost C group,at the start of the total occlusion of co ronary artery reocclusion,four cycles of 60 s reperfusion and 60 s occlusion was given within 1 minute,then implanted stents.The surgical method of normal operation group is the same as IPost C group except the IPost C operative procedure.The incidence of MNR was compared within this 2 groups.(3)In 93 eligible STEMI patients,blood sample were obtained from the peripheral venous blood before PCI,immediate postoperative and 3d after operation.Plateletlym phocytic aggregation were further analyzed by flow cytometry.No reflow was defined as coronary blood flow grade TIMI?2 in the absence of anatomic stenosis and vascular spasm.Results:(1)Compared with the control subjects,the risk of factors for coronary heart di sease(for example hypertension,diabetes,smoking and hyperlipidemia),the platelet counts,leukocyte counts were significantly higher in STEMI group(P<0.05),and all patients with STEMI had higher Ply A expression levels(P<0.01).In univariable logistic regression models,the platelet counts,leukocyte counts and Ply A levels before operation were all found to be positively associated with the risk of STEMI(P<0.05).T he subsequent multiple analysis showed that the leucocyte counts(OR=2.04,CI1.542.78;P<0.001)and the levels of Ply A before operation(OR=1.32,CI1.101.56;P=0.002)continued to demonstrate strong positive associations with the risk of STEMI.(2)After PCI,a total of 24(25.8%)STEMI patients happened MNR.The reflow group and noreflow group showed no significant difference in age,coronary heart disease(for example hypertension,diabetes,smoking and hyperlipidemia),sensitive troponin I,CKMB and medication history.Compared with the reflow group,the circulating levels of Ply A before operation were significantly higher in noreflow group(P<0.001)and had a higher thrombus score(P<0.001)and lesion length(P=0.002).In univariab le logistic regression models,lesion length,thrombus score?4 and Ply A levels before operation were all found to be positively associated with the risk of MNR(P<0.05).After adjusting for these factors,thrombus score?4(OR=23.26,CI1.0941.67;P=0.048)and Ply A levels before operation(OR=1.69,CI1.032.78;P=0.036)continued to demonstrated strong positive associations with the risk of MNR.(3)The circulating levels of Ply A before operation had no significantly difference between IPost C group and normal operation group(P=0.742).Compared with the normal operation group,the IPost C group had downward trends in the expression levels of Ply A immediate postoperative and 3d after operation,but there were no significant difference.(4)Compared with normal operation group,the occurrence of MNR in the IPost C group was lower(P=0.021),there had significant difference.Conclusions:(1)Compared with the control subjects,the circulating levels of Ply A were significantly higher in the patients with STEMI.It suggested that the higher circulating levels of Ply A demonstrate positive associations with the risk of STEMI.(2)Compared with normal reflow group,the circulating levels of Ply A were significantly higher in noreflow group.It suggested that the higher circulating levels of Ply A could predict the occurrence of MNR and be regarded as a risk factor for MNR.(3)Compared with normal operation group,the occurrence of MNR in the IPost C group was significantly lower.It showed that IPost C could reduce the occurrence of MNR and protect heart function.And the IPost C group had obviously downward trends in the circulating levels of Ply A,but there were no significant difference.