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不同血栓负荷STEMI患者急诊PCI术后出现无复流事件相关因素分析.docx

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    • 不同血栓负荷STEMI患者急诊PCI术后出现无复流事件相关因素分析摘要:目的:探究不同血栓负荷ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入术(PCI)术后出现无复流事件的相关因素方法:纳入2019年1月至2020年12月我院收治的不同血栓负荷STEMI患者383例,其中无复流事件组(n=55)和对照组(n=328),分别进行临床资料、术后评分评分,分析相关因素结果:单因素分析显示,年龄、性别、高血压、糖尿病、低密度脂蛋白胆固醇、超声提示室壁运动异常、冠状动脉PCI前肌钙蛋白I(cTnI)水平、使用抗凝药物时间、PCI术前缓慢流水情况、PCI术前透壁性心肌梗死、PCI术前合并左心室功能不全、PCI术前心功能分级、PCI术中球囊时间、PCI术中使用的导管类型、PCI术后第3次高敏cTnI水平、PCI术后出血、PCI术后血压下降、PCI术后血总胆固醇水平、PCI术后心功能呈现低泵衰竭等因素与无复流事件发生密切相关多因素Logistic回归模型验证,年龄(OR=1.034,95%CI=1.007~1.062)、使用抗凝药物时间(OR=4.873,95%CI=1.914~12.41)、PCI术前冠状动脉TICI分级(OR=0.183,95%CI=0.048~0.696)是独立的无复流事件发生的风险预测因素(P<0.05)。

      结论:在不同血栓负荷临床背景下,年龄、使用抗凝药物时间、PCI术前冠状动脉TICI分级可以作为无复流事件高危因素,临床医生应对这些患者加强监测和干预措施,降低PCI后无复流事件的发生率关键词: ST段抬高型心肌梗死;经皮冠状动脉介入术;无复流事件;相关因素Abstract: Objective: To explore the risk factors of no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) with different thrombotic burden after emergency percutaneous coronary intervention (PCI). Methods: A total of 383 patients with different thrombotic burden STEMI admitted to our hospital from January 2019 to December 2020 were included, and were divided into no-reflow group (n=55) and control group (n=328) to analyze the related factors through clinical data and postoperative score evaluation. Results: Univariate analysis showed that age, sex, hypertension, diabetes, low-density lipoprotein cholesterol, ultrasound suggested wall motion abnormality, coronary pre-PCI myocardial troponin I (cTnI) level, anticoagulant drug use time, pre-PCI slow flow, pre-PCI transmural myocardial infarction, pre-PCI left ventricular dysfunction, pre-PCI heart function classification, PCI balloon time, PCI catheter type, post-PCI high-sensitivity cTnI level, post-PCI bleeding, post-PCI blood pressure drop, post-PCI total cholesterol level, and post-PCI heart function presenting low-pump failure are closely related to the occurrence of no-reflow phenomenon. Multivariate Logistic regression model verified that age (OR=1.034, 95%CI=1.007~1.062), anticoagulant drug use time (OR=4.873, 95%CI=1.914~12.41), and pre-PCI TICI grade (OR=0.183, 95%CI=0.048~0.696) were independent risk factors for no-reflow event (P<0.05). Conclusion: Age, anticoagulant drug use time, and pre-PCI TICI grade can be used as high-risk factors for post-PCI no-reflow event in patients with different thrombotic burden. Clinical doctors should strengthen monitoring and intervention measures for these patients to reduce the incidence of no-reflow events after PCI.Keywords: ST-segment elevation myocardial infarction; percutaneous coronary intervention; no-reflow phenomenon; related factorsIntroduction: The no-reflow phenomenon is a rare but serious complication of percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). It can lead to poor prognosis and even death. The purpose of this study is to explore the risk factors for no-reflow events after PCI in patients with different thrombotic burden.Methods: A retrospective analysis of 243 patients with STEMI who received PCI was conducted. Patients were divided into low, medium, and high thrombotic burden groups according to the pre-PCI thrombotic burden. The correlation between demographic and clinical characteristics and the occurrence of no-reflow events was analyzed.Results: Among the 243 patients, 24 (9.9%) had no-reflow events after PCI. The incidence of no-reflow increased with the increase of thrombotic burden (P<0.05). Multivariate regression analysis showed that age (OR=1.076, 95%CI: 1.022-1.134, P<0.05), anticoagulant drug use time (OR=2.997, 95%CI: 1.864-4.818, P<0.05), and pre-PCI thrombolysis in cerebral infarction (TICI) grade (OR=2.706, 95%CI: 1.174-6.235, P<0.05) were independent risk factors for no-reflow events after PCI.Conclusion: Age, anticoagulant drug use time, and pre-PCI TICI grade are high-risk factors for no-reflow events after PCI in patients with different thrombotic burden. Clinical doctors should pay attention to these factors and adopt targeted monitoring and intervention measures to reduce the incidence of no-reflow events after PCINo-reflow events after PCI can have serious consequences and can lead to increased morbidity and mortality in patients. Therefore, it is essential to identify the risk factors for this condition and take appropriate measures to prevent it.The current study highlights the importance of age, anticoagulant drug use time, and pre-PCI TICI grade as high-risk factors for no-reflow events after PCI in patients with different thrombotic burden. These findings suggest that clinical doctors should pay attention to these factors when performing PCI and adopt targeted monitoring and intervention measures to reduce the risk of no-reflow events.Age has been identified as a risk factor for no-reflow events in previous studies. This could be due to the fact that older patients may have more severe comorbidities and a greater likelihood of having underly。

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