| Objective:Acute ST segment elevation myocardial infarction(STEMI)is one of the most serious clinical manifestations of coronary atherosclerotic heart disease.Percutaneous coronary Intervention(PCI)therapy restores myocardial perfusion by opening infarctionrelated artery(IRA),which is the gold standard for acute STEMI.But timely coronary revascularization without residual anatomic stenosis does not always quickly restore antegrade coronary blood flow and complete myocardial reperfusion.This condition is called Coronary No-Reflow(CNR)and is related to major clinical adverse events and adverse prognosis.The early clinical manifestations of patients with CNR injury include recurrent angina pectoris,malignant arrhythmias(such as ventricular tachycardia,ventricular fibrillation and atrioventricular block),acute left heart failure,cardiogenic shock,cardiac rupture or other malignant complications.At present,there is no general consensus on the correct prevention and management of CNR.Atherogenic Index of Plasma(AIP),as a non-traditional blood lipid index,is calculated by LOG(TG/HDLC),which more comprehensively reflects the balance between atherogenic factors and anti-atherosclerotic factors,and AIP has been proved to be an important index for predicting CHD.Because of the poor prognosis of CNR phenomenon in patients with acute STEMI,the purpose of this study is to explore the Predictive value of AIP for CNR after Primary PCI in elderly patients with acute STEMI,and to provide a simple and effective new index to guide clinicians to identify and intervene effectively before operation as early as possible,so as to reduce the complications of patients and improve their prognosis.Methods:Elderly patients with acute STEMI(age ≥ 60 years old)who received primary PCI in the Department of Cardiology,Subei people’s Hospital of Jiangsu Province from June2018 to June 2022 were excluded.Patients who received thrombolytic therapy before primary PCI,symptoms lasting more than 12 hours,no stent implantation during operation,statins,Bette drugs before primary PCI,end-stage liver and kidney diseases,blood coagulation disorders,malignant tumors and incomplete clinical data were excluded.According to the TIMI blood flow grade after PCI,the patients were divided into two groups: reflow group(n = 257,TIMI > grade 2)and no reflow group(n = 74,TIMI ≤ grade 2).The general clinical data of patients at admission were collected,including age,sex,height,weight,history of hypertension,history of diabetes,smoking,drinking,heart rate and blood pressure at admission(measured 3 times,interval 1-2min,average),surgical records,Killip cardiac function classification,major adverse cardiovascular events(MACEs)and postoperative Left ventricular ejection fraction(LVEF).Venous blood 5ml was drawn from all patients before direct PCI,and the blood and biochemical indexes were tested according to the standard of laboratory medicine of Subei people’s Hospital of Jiangsu Province.SPSS25.0 statistical software was used for statistical analysis.Results:1.Age(72.1±7.5 VS 69.8±7.2,P=0.019),heart rate at admission(81±15.8VS 76.9±14.9,P=0.042),percentage of diabetes(40.5% VS 26.8%,P=0.023),admission glucose values [7.3(5.6,10.8)VS 5.8(5.1,7.6)P<0.001],TG [1.55(1.18,2.04)VS 1.24(0.94,1.67),P<0.001],AIP(0.21±0.26 VS 0.06±0.23,P<0.001),pre-PCI TIMI < grade 3(86.5% VS 73.5%,P=0.021),tirofiban use(28.4% VS 10.2%,P<0.001)were significantly higher than those in the reflow group,and the difference was statistically significant(P<0.05).HDL-C in the no-reflow group [1.01(0.89,1.19)VS 1.10(0.95,1.34),P=0.001] was significantly lower than that in the re-flow group,and the difference was statistically significant(P<0.05).2.The incidence of acute heart failure(25.7% VS 13.6%,P=0.013),recurrent myocardial infarction(6.8% VS 0.7%,P=0.005),and the proportion of MACEs(32.4% VS 17.5%,P=0.005)were significantly higher in the noreflow group than in the reflow group,and the differences were statistically significant(P<0.05).3.After adjusting for confounding factors,multifactorial logistic regression analysis revealed that age,blood glucose,pre-PCI TIMI < grade 3,and AIP were independent risk factors for the development of postoperative CNR.4.ROC curve analysis showed that the area under the curve(AUC)of AIP for predicting CNR after primary PCI in patients with acute STEMI was 0.667 [95% CI(0.597-0.738),P < 0.001],with a best cut-off value of 0.134 and a sensitivity and specificity of 66.2% and 62.6%,respectively.The predictive efficacy of AIP was greater than that of TG AUC of 0.638 [95% CI(0.568-0.708),P<0.001] and HDL-C AUC of0.626 [95% CI(0.556-0.696),P=0.001].Conclusion:1.In elderly patients with acute STEMI,the proportion of MACEs in hospital is higher in patients with CNR after primary PCI,suggesting that the prognosis is poor.2.AIP,age,blood glucose and TIMI < 3 before PCI are independent risk factors for CNR after direct PCI in elderly patients with acute STEMI.3.AIP=0.134 is the best predictive cut-off point for CNR after primary PCI in elderly patients with acute STEMI,with an area under the curve of 0.667,with a sensitivity and specificity of 66.2% and 62.6%,respectively.4.AIP is an easily obtained index in clinic,and it has a certain predictive value for the occurrence of CNR after primary PCI in elderly patients with acute STEMI,and the predictive ability is higher than that of TG and HDL-C. |
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