| Objective: To investigate the related factors of myocardial microcirculation perfusion disorder after primary percutaneous coronary intervention(p PCI)in ST segment elevation myocardial infarction(STEMI).Methods: We collected patients with STEMI undergoing p PCI from February 2015 to December 2016 in the Second Hospital of Hebei Medical University.According to TIMI myocardial perfusion grade(TMPG),the patients were divided into two groups: Group A(TMPG 0-2)and Group B(TMPG 3).The clinical baseline data were collected: age,gender,smoking history,hypertension,diabetes,dyslipidemia,body mass index(BMI).Record parameters before and within operation: serum potassium,creatinine,hemoglobin,platelet count,low density lipoprotein(LDL),activated clotting time(ACT),creatine kinase-MB(CK-MB),cardiac troponin I(c Tn I),Killip classification,systolic blood pressure,diastolic blood pressure,heart rate,onset to first medical contact(FMC),FMC to heparin time(FMC-H),door to balloon(D-B),aspiration catheter,multi-vessel disease,preoperative and postoperative TIMI blood flow,infarct related artery(IRA),the number of stents,the length and diameter of the stent,pre-dilation,post-dilation,stent extension pressure,intracoronary tirofiban or anisodamine and so on.All the data were analyzed by SPSS 16.0,P<0.05 was considered statistically significant.Multivariate logistic regression analysis was used to investigate the independent risk factors of myocardial microcirculation perfusion disorder in patients with STEMI undergoing p PCI.Results: A total of 122 eligible patients were enrolled,18(14.75%)in Group A and 104(85.25%)in Group B.There were no significant differences between two groups in gender,age,smoking history,BMI,hypertension,dyslipidemia,systolic blood pressure,diastolic blood pressure and heart rate(P>0.05).While the proportion of diabetes in Group A was significantly higher than that in Group B,which was statistically significant(44.44% vs.21.15%,P=0.034).There were no significant differences in serum potassium,creatinine,hemoglobin,platelet count,LDL,baseline ACT,CK-MB,c Tn I and Killip classification(P>0.05).In the two groups,IRA,stent diameter,stent length,extension pressure,post-dilation pressure,preoperative TIMI blood flow and postoperative TIMI blood flow(2)were not statistically significant(P>0.05).Compared with Group B,thrombus aspiration(44.44% vs.1.92%,P<0.001),multi-vessel disease(77.8% vs.47.1%,P=0.016),tirofiban(50.00% vs.23.1%,P=0.018)and anisodamine(61.1% vs.17.3%,P<0.001)were significantly higher in Group A.The post-dilation in Group A was higher than that in Group B(50% vs.20.19%,P=0.007),and the average postoperative extension pressure was higher than that in Group B(0.89±1.02 atm vs.0.28±0.60 atm,P=0.024).The proportion of TIMI blood flow 3 in Group A was significantly lower than that in Group B(44.4% vs.76.9%,P=0.011).There was no significant difference in D-B time between the two groups(P>0.05).Compared with Group A,onset to FMC(6.60±2.61 h vs.3.96±1.72 h,P<0.001)and FMC-H(2.74±1.36 h vs.1.38±0.72 h,P<0.001)were much earlier in Group B.Multivariate logistic regression analysis showed: onset to FMC and FMC-H were two independent risk factors for myocardial microcirculation infusion in STEMI patients undergoing p PCI.Conclusion: For the treatment of patients with STEMI,we should shorten the total ischemic time of the heart,including timely treatment,administering heparin as soon as possible to block clotting waterfall,etc.,to prevent myocardial microcirculation perfusion disorder and myocardial ischemia-reperfusion injury and to save high-quality life. |
