The Study Of Coronary Microvascular Dysfunction And No-reflow Phenomenon

Relationship between Serum y-gamma-glutamyl transferase and coronary microcirculation resistance indexObjective:Coronary microcirculation is mainly responsible for regulating myocardial blood flow and exchange of nutrients and metabolites in the myocardium.It is believed that coronary microvascular dysfunction(CMD)is also one of the basic mechanisms of coronary heart disease The index of microcirculatory resistance(IMR)is an invasive assessment of coronary microcirculation.It has the advantages of simple operation,high reproducibility,and no influence on the coronary circulation of the epicardial membrane.?-gamma-glutamyl transferase(?-GGT)is an endogenous antioxidant,which is mainly involved in the metabolism of glutathione in the body.Recent studies have found that ?-GGT is closely related to cardiovascular disease.This study is to investigate the correlation between the levels of ?-GGT and IMRMethods:A total of 44 patients hospitalized in the Department of Cardiology from March 2013 to December 2017 were enrolled.Coronary microcirculation resistance index was measured in patients with negative coronary angiography results.According to the IMR value,they were divided into two groups:IMR<25 group(n=29)and IMR>25 group(n=15).The clinical information,y-GGT,high-density lipoprotein cholesterol were detected.The correlation between y-GGT and IMR was analyzedResults:1.There was no statistical differences in clinical basic data among gender,age,history of hypertension,history of diabetes,history of smoking,total cholesterol,triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,aspartate aminotransferase,and alanine aminotransferase(P>0.05).2.According to the median and quartile of ?-GGT serology[30(17.25,41.5)],the patients were divided into four groups,and patients with y-GGT>51.5U/L group had obvious high IMR levels.It was higher than the other three groups of ?-GGT serological levels,and the ratio of IMR>25 was the largest(54.55%)in the group,but there were no statistically significant differences between the groups.3.Pearson correlation analysis showed that serum y-GGT was significantly correlated with IMR(r=0.401,P<0.01).However,there was a negative pearson correlation between high density lipoprotein cholesterol and IMR(r=-0.320,P<0.05).4.On serum y-GGT levels and IMR value linear regression analysis,the results of the level of serum y-GGT and IMR values exist linear relationship(t=2.838 P=0.007),and the results of the level of serum HDL-C and IMR values exist linear relationship(t=-2.185,P=0.034)?Conclusion:1.There is a linear correlation between serum ?-GGT level and IMR.?-GGT has a certain predictive effect and can be used to evaluate the severity of coronary microcirculation.2.The decreasing of HDL-C level may be involved in the pathological process of CMD.Combination of SYNTAX ? score and Neutrophil-lymphocyte ratio as a predictor of no-reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarctionAim:Acute ST-segment elevation myocardial infarction(STEMI)is one of the most serious emergencies in cardiovascular disease.Primary percutaneous coronary intervention(pPCI)is currently the main therapeutic strategy for STEMI patients,which can reopen occlude Coronary vessels as soon as possible,limiting myocardial progression and necrosis,reducing mortality and improving early and long-term prognosis.However,in some patients with STEMI after myocardial ischemia,successful reopening of an occluded epicardial coronary artery does not signify complete myocardial perfusion and left ventricular functional recovery.The no-reflow(NR)phenomenon refers to the absence of the myocardial ischemic area after restoration of the infarct-related artery.The anatomical SYNTAX score(SS)is based on the complexity of coronary anatomy,which can help clinicians to revascularization decisions and predict long-term mortality and morbidity.SYNTAX ? score(SS ?)contains six clinical variables,including age,sex,creatinine clearance,peripheral vascular disease,chronic obstructive pulmonary disease and left ventricular ejection fraction,and unprotected left main coronary artery(ULMCA)disease.Although the relationship between coronary artery complexity and NLR has been previously investigated.In the existing study,we designed to investigate the prediction effect of SS ? and NLR on the NR phenomenon in patients who underwent pPCI for ST-segment elevation myocardial infarction(STEMI).Methods:This study included 203(163 males and 40 females,age mean 59.86±12.12 years)consecutive STEMI patients who underwent pPCI between January 2017 and September 2018.The angiographic certification were mainly determined by a thrombosis in myocardial infarction(TIMI)flow grade of 2 or less after the end of the PCI process.Upon the TIMI flow grade results of the IRA,patients were divided into normal flow and no-reflow groups.According to the three classification methods based on the results of SS ? integration,they were divided into low-risk(SS ?<22),medium-risk(22<SS ?<31)and high-risk(SS ?>31)groups.The comparison of categorical data was used by chi square or Fisher exact test.In order to compare the three groups,one-way analysis of variance was used.Receiver-operating characteristic(ROC)curves were constructed to predict no-flow phenomenon.A two-sided P<0.05 was considered as statistically significant.Results:1.There were significant differences between the normal group and the no-reflow group,age,multi-vessel disease,lymphocyte count,lipoprotein a,NLR,left ventricular ejection fraction,SS,SS?(P<0.05).2.According to the SS ? score,gender,age,history of hypertension,history of smoking,multi-vessel disease,no-reflow,white blood cells,lymphocytes,platelets,blood urea nitrogen,triglyceride,HDL-C,lipoprotein a and LVEF were found significant differences between the SS?>31 group and SS ?<22 group in pairs(P<0.05).However,Gender,age,HDL-C,LVEF,eGFR and SS ?<22 and intermediate-risk group were two-phase.The difference was statistically significant(P<0.05 or P<0.0167).3.Age,Lymphocytic count,LVEF,NLR,SS,SS ? were significant in univariate analysis.The multivariate analysis was repeated until all variables in the logistic regression were obtained to be significant.According to the results of the Logistic analysis,SS ?(odds ratio[OR]:1.055,95%confidence interval[CI]:1.018-1.094,P=0.003),NLR(odds ratio[OR]:1.097,95%confidence interval[CI]:1.014-1.188,P=0.022)were the independent predictors of no-reflow.4.The ROC curve analysis for SS ? score and NLR were performed to detect the prediction of no-flow phenomenon.The results showed that the area under the curve(AUC)of SS ? score was 0.648(95%CI:0.558,0.739,P<0.002),furthermore,the SS value>28.85 demonstrated a sensitivity of 60.8%and a specificity of 65.1%for the prediction of no-reflow.Also,the ROC curve analysis was performed to detect the best cut-off value of NLR in the prediction of no-reflow.NLR value>6.38 yielded an AUC value of 0.611(95%CI:0.520,0.730,P=0.018).Furthermore,a NLR value>6.38 demonstrated a sensitivity of 56.9%and a specificity of 68.4%for the prediction of no-reflow.And the AUC value of SS ? score and NLR was 0.668(95%CI:0.575,0.760,P<0.001).Conclusion:1.SS ? score and NLR were significantly different in no-reflow group compared to the normal flow group.2.The SS ? score and NLR independently predicted of NR in STEMI patients.3.The combination of SS ? score and NLR can improve the predictive power of NR in STEMI after pPCI.