Analysis Of Risk Factors Of No-reflow Phenomenon After Direct Percutaneous Coronary Intervention In Patients With Acute Myocardial Infarction

Background and Object:Percutaneous coronary intervention after acute myocardial infarction is the preferred treatment for revascularization.PCI can restore normal blood flow to the infarct related artery of the patients,and the myocardial perfusion of most patients is effective,but there are still some patients who cannot obtain normal blood perfusion even after opening IRA,so there is no reflow.It can lead to complete myocardial necrosis,enlarged infarction range,ventricular dilatation and remodeling,leading to heart failure,malignant arrhythmia and other complications,which seriously affect the prognosis of patients.Therefore,whether myocardial perfusion is effective after PCI in AMI patients is the primary problem for the success of PCI.However,at present,studies on risk factors,pathophysiological mechanism,diagnosis,prevention and treatment of no reflow are still unclear.In this paper,by studying the risk factors of the no reflow phenomenon,so as to identify the high risk factors,provide effective measures for the prevention and treatment of PCI,and reduce the occurrence of major adverse cardiovascular events(MACE)and further improve the survival rate.Methods:Collected the complete information of a total of 213 patients,with acute myocardial infarction treated with PCI in the China-Japan Union Hospital from January 2017 to January 2020.According to the criteria of thrombolytic blood flow classification(thrombolysis in myocardial infarction,TIMI),the patients were divided into two groups,with anterior coronary blood flow TIMI?2 was diagnosed as no reflow,while TIMI grade 3 was defined as normal blood flow.Including 98 patients with no reflow group,115 patients with normal blood flow.By comparing the basic clinical data,coronary angiographic characteristics and related biochemical indicators of patients in the two groups,to analyze risk factors of no reflow after AMI.By chi-square test,t test,nonparamrtric test can find univariate variables with statistical significance.Logistic regression analysis selecting the risk factors of no reflow after PCI in acute myocardial infarction patients.Finally,the optimal critical point for continuous variable prediction is obtained.Results:According to comparing the related factors between normal blood flow and no reflow,using chi-square test,rank sum test,t test,found no reflow group in age,Killip?II,myocardial infarction to vessel opening time,TIMI flow grade,TIMI flow grade?1,thrombosis load,thrombosis load?4,collateral circulation,collateral circulation?1,ST-elevation number,ST-elevation number?4,the scope of ST segment elevation,the scope of ST segment elevation?0.4,white blood cells,N/L that the difference was statistically significant(P<0.05)compared with the normal blood flow group.By Logistic regression analysis,the age,to the patency of the time,TIMI flow grade?1,thrombosis load?4,thrombosis load?4,ST-elevation number?4,white blood cell count would be independent risk factors of no reflow.Conclusion:1.Age,myocardial infarction to vessel opening time,white blood cells,TIMI flow grade?1,thrombosis load?4,collateral circulation?1 and ST-elevation number?4 can be significantly correlated with the occurrence of no-reflow and be used as independent risk factors for the occurrence of no re-flow in AMI patients after PCI,and collateral circulation?1 can significantly affect the occurrence of no reflow in AMI patients.2.Age,myocardial infarction to vessel opening time and the total number of white blood cells can be used as independent risk factors for no-reflow after PCI for myocardial infarction,and the optimal threshold respectively is 67.5 years,7.5h and12.955~*10~9/L.