| BACKGROUND With the improvement of residents’ living standards,acute ST segment elevation myocardial infarction has become the biggest killer endangering health.Percutaneous coronary intervention can effectively dredge the infarct-related artery,restore the blood supply,and protect the residual myocardial function.It was found that some patients had occurred spontaneous reperfusion(SR)in IRA before PCI.Some studies have shown that SR can improve the rate of operation successfully,reduce the rate of the major adverse cardiovascular events,and improve the prognosis.There have been reports about the influence factors of SR,but there are disputes.Therefore,the purpose of this study is to investigate the factors of spontaneous reperfusion and to evaluate the effect of spontaneous reperfusion on the prognosis of patients with STEMI.METHODS A total of 288 patients with STEMI who underwent primary percutaneous coronary intervention within 12 hours from January 2015 to September 2019 were enrolled.Patients were divided into the spontaneous reperfusion group(SR group,TIMI flow grade 2 or 3)and the non-spontaneous reperfusion(control group,TIMI flow grade0 or 1)according to the angiography.The clinical and angiographic characteristics,laboratory indicators,and major cardiovascular events were analyzed.RESULTS Compared to the control group,patients in the SR group were younger,had more angina,previous statin usage,shorter visit times and higher blood pressure at admission(P<0.05).Compared to the control group,the higher value of D-dimer in SR group,but the Red blood cell distribution width(RDW),neutrophil-lymphocyte ratio(NLR),neutrophil percentage-albumin ratio(NAPR),platelet-lymphocyte ratio(PLR),monocyte-high density lipoprotein ratio(MHR),lipoprotein-a and fibrinogen,serum creatinine,uric acid,CK-MB and c Tn I were lower(P<0.05).The SR group had the higher proportion of anterior wall infarction,left anterior descending branch(LAD)and single-branch lesion,but the collateral circulation was less(P<0.05).In the SR group,the average length of stay was shorter,and the proportion of MACE was lower in the hospital and 6 months after surgery,and the left ventricular function was better.Multivariate Logistic regression analysis showed that the NAPR,PLR and MHR,D-dimer and area of infarction were associated independently with SR(P<0.05).ROC curve was performed for three indexes less studied,the area under the PLR,NAPR and MHR curves were 0.762(95%CI 0.699,0.825),0.749(95%CI 0.689,0.809)and 0.63(95%CI 0.554,0.707),P<0.05,respectively.PLR and NAPR had better predictive values,with diagnostic cutoff values of 89.21 and 1.56,sensitivity of 80% and 74.3%,and specificity of 63.8% and 66.5%,respectively.CONCLUSION Spontaneous reperfusion is associated with multiple factors,which are controllable,such as chronic statin treatment,shortening the time from onset to diagnosis.Controlling controllable factors can improve the incidence of SR and the prognosis of patients. |
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