The Exploration Of Mechanism Of No-reflow In The Patients With Percutaneous Coronary Intervention Of Acute Coronary Syndrome

Objective: In this study,the patients accepted the Percutaneous Coronay Intervention(PCI) by reason of Acute Coronary Syndrome(ACS), whether the occurrence of no-reflow phenomenon,were divided into two groups. Each group of patients were detected Endothelial Microparticles(EMPs),soluble Intercelluar Adhesion Molecule-1, Nitric Oxide(NO),von Willetr-and Factor(v WF) in the circulation of blood both in the preoperative and postoperative. From the aspects of Coronary artery endothelial function,to understand and analyze the relations between the PCI surgery and no-reflow. Methods: 60 ACS patients for PCI hospitalized at the Cardiology department of Yan’an University Affiliated Hospital from September 2013 to Septemberr 2015 were assigned into group A(no-reflow group,n=30) and group B(normal-blood group,n=30) according to the Corrected TIMI Frame Count(CTFC).Venous blood was collected in the preoperative and postoperative, venous blood samples, EMPs detected by Flow cytometry(FCM),s ICAM-1 and v WF detected by Enzyme Linked Immunosorbent Assay(ELISA), NO detected by Nitric Oxide assay kit. The relations between the above indicators and no reflow were analyzed.The data collected were analyzed by SPSS17.0 software.Result: 1. Comparison of the general data of preoperative among A, B two groups of patients: Gender, Age, BMI, Hypertension, Abnormal Lipid Metabolism, Diabetes, Smoking, Killip class, Q wave count, Family history of heart disease and Ischemic preconditioning showed no statistical difference(P > 0.05). 2. Comparison of the PCI related information among A, B two groups of patients: Coronary angiography results(Lesion vessel number,The distribution of the coronary artery lesions,Interventional treatment) showed no significant difference(P > 0.05). 3. Comparison of plasma EMPs, serum s ICAM-1, NO, v WF levels of A, B two groups of patients before PCI: there were significant differences in statistics(P<0.05). 4. Comparison of plasma EMPs, serum s ICAM-1, NO, v WF levels of A, B two groups of patients after PCI: there were significant differences in statistics(P<0.05). 5. Comparison of plasma EMPs, serum s ICAM-1, NO, v WF levels of A group of patients in the preoperative and postoperative have significant difference(P < 0.05), amplitude of variation respectively: 80.74±22.92、31.98±4.12、-28.12±7.33、66.95±15.63; Comparison of plasma EMPs, serum s ICAM-1, NO, v WF levels of B group of patients in the preoperative and postoperative have significant difference(P < 0.05), amplitude of variation respectively: 57.74±33.45、15.99±10.75、-19.34±3.94、41.52±18.40.For A, B two groups compared, two of each index changes were significant differences in statistics(P < 0.05). 6. The correlation analysis between A group of patients of plasma EMPs and serum s ICAM-1, NO and v WF levels before PCI and CTFC. The results showed that preoperative EMPs or s ICAM-1 or v WF levels and CTFC were positive correlation(P < 0.05), preoperative NO and CFTC were negative correlation(P < 0.05). 7. Whether the occurrence of no-reflow phenomenon as Dependent variable, A and B two groups preoperative plasma EMPs and serum s ICAM-1, NO, v WF as Independent variables,The result of multi factor Logistic regression analysis showed that the Odds ratio of preoperative plasma EMPs and serum s ICAM-1, NO, v WF and no- reflow after PCI were 1.125, 1.028, 0.662, 1.03(P < 0.05). Conclusion: 1. The ACS patients’ plasma EMPs and serum s ICAM-1 and v WF levels after PCI compared with the preoperative increased significantly, serum NO level after PCI compared with the preoperative decreased significantly.The increased amplitude of plasma EMPs or serum s ICAM-1 or v WF and the decreased amplitude of serum NO in no-reflow group compared with normal-blood group’ have more significant changes. This suggests that no-reflow group of patients with vascular endothelial and myocardial injury compared with normal-blood group is more serious. 2. Plasma EMPs and serum s ICAM-1 and v WF before PCI were related positivly with no-reflow phenomenon after PCI, but serum NO was oppsite. 3.The changes of plasma EMPs and serum s ICAM-1, NO and v WF reflects that coronary artery endothelium’ inflammatory reaction and damage degree and diastolic dysfunction in no-reflow patients. 4.Plasma EMPs and serum s ICAM-1 and v WF before PCI are risk factors of no-reflow phenomenon after PCI, and serum NO before PCI is a protective factor.