Analysis On The Risk Factors And Relatetive Evaluation Related To The "No-Reflow" Phenomenon After Reperfusion Therapy Of Emergent Percutaneous Coronary Intervention

Emergent percutaneous coronary intervention is the mosteffective therapy method for acute myocardial infarction nowadays.But no-reflow phenomenon for some patients after PCI couldn't makecardiac tiny-circlulation have effective perfusion although the IRAopen, it becomes one of the most factors to influence the prognosis. Itdid't have the whole-systemic investigation nowadays about analysison the risk factors and relatetive evaluation related to the "no-reflow"phenomenon, less relative report, also have no consistent conclusion.In our thesis we choose thirty-seven patients with no-reflowphenomenon after PCI, contrasting sixty patients with normal TIMIblood stream after PCI, and we make single-variable andmore-variable review analysis about relative risk factors. Result: 1.Age,sex,smoke,hypertension,side-circulation,TIMI blood streamclassification before emergent PCI,IRA,CKmax,CK-MBmax,PT,APTT have no notable difference between no-reflow and blank group.2. High-cholesterol blood-sickniss , obesity, diabetes mellitus ,rebuilding-time of IRA,angina before infarction,Killip classification,the count of Q-wave,WMS,FIB have notable difference betweenno-reflow and blank group. 3. Making more-factors analysis of themethod of Logistic reveals: their Ch-square count from big to small inturn are the count of Q-wave (Ch-square=5.33),angina beforeinfarction (Ch-square=4.68),Killip classification (Ch-square=4.10),FIB (Ch-square=4.01),WMS (Ch-square=3.95),rebuilding-time ofIRA (Ch-square=3.89) , High-cholesterol blood-sickness(Ch-square=3.63),obesity (Ch-square=3.01). The biggest one ofCh-square is Q-wave, that is the strongest relative factor. Theirreliability in turn are 1.09-1.72;0.13-0.90;1.08-6.37;0.52-1.10;0.57-1.68;1.01-1.32;0.73-1.53;0.89-2.69. STI one week after PCI isa simple and credible target to estimate no-reflow phenomenon. STI inthe no-reflow group elevates ten minutes after IRA-rebuilding, anddescends afterward, but maintain the level before operation withintwelve hours;normal blood stream group maintain the level beforeoperation within ten minutes after IRA rebuilding, and descendsafterward, descends exceed 50% at thirty minutes;although decsendswithin twelve hours, but have no notable difference contrasting thirtyminutes. Within twelve hours after PCI, in the sixty patients of blankgroup, there are fifty-three cases descending exceed 50%, but onlyfour in thirty-seven-case of no-reflow group. ΣSTI elevates exceed30% ten minutes after PCI, thirty-three case in no-reflow group, butseven in the blank.In the forty case with ΣSTI persistent elevation,there are thirty-three showing no-reflow, and seven showing normalblood stream. in the fifty-seven case with ΣSTI descending,only fiveshow no-reflow, fifty-two in blank group. Monomial variation analysisshow ΣSTI among ten-minutes thirty-minutes and twelve-hours haveno notable difference. 5. Two weeks after PCI compared withbefore-PCI, in blank group the movement of ventricular wall is better,with elevation of LVEF,CI,SVI;but no evident change in no-reflowgroup. Two weeks after PCI compared with before-PCI, in the blankgroup combinating heart failure the movement of ventricular wall isbetter, with elevation of LVEF,CI,SVI and with decline of LVEDV,LVESV;in no-reflow group the movement of ventricular wall has nochange, with elevation of LVEF,CI,SVI and with decline ofLVEDV,LVESV.In our investigation we make high-cholesterol blood-sickness bethe contrast factor first for no-reflow and blank group, and showhigh-cholesterol blood-sickness for no-reflow and blank group havenotable difference. We consider that high-cholesterol blood-sicknesscan restrain the open of KATP-channel, advancing no-reflow andrestrain cicatrization of myocardial infarction. And we make theconclusion that FIB≥400mg/ml and obesity are the independent riskfactors of no-reflow after emergent PCI. Our investigation providethat in the early stage of reperfusion the variation of STI can forecastno-reflow phenomenon after emergent PCI simplely, it also haveguidance meaning in the clinic. And we analyse LVEF,CI,SVI,LVEDV,LVESV, it shows that the case with no-reflow combinedheart failure not only have the decline of stretch-contract function ofleft ventricle, but also make dimension of left ventricle in thetelophase bigger to maintain the pump function of heart. The objectivein our investigation are the patients after emergent PCI in our hospital,also single-centre research, and it have some statistics value andmeaning. But considering the less cases and some case lost because ofinadequate data, it should be approved by look-up and bigger swatchwith long-period visit.