Observation Of No-reflow Phenomenon After Emergency PCI In STEMI Patients

Objective In patients with acute ST-segment elevation myocardial infarction who underwent emergency PCI within 12 hours,analyze the existence of a statistically significant difference between the no-reflow group and the normal blood flow group after stent implantation.Analyze the independent risk factors of no-reflow phenomenon in this type of patients after PCI,hoping to provide relevant reference of clinical prevention and treatment for no-reflow phenomenon in the future.Methods Retrospectively analyze the patients with acute ST-segment elevation myocardial infarction who underwent emergency PCI within 12 hours of admission,a total of 411 people.All patients were divided into two groups according to the TIMI blood flow evaluation method: the no-reflow group(TIMI 0?1?2),the normal blood flow group(TIMI 3).Collect basic clinical data for all patients: age,sex,smoking history,drinking history,history of hypertension,history of diabetes,history of cerebrovascular disease,family history of coronary heart disease,angina pectoris,time of admission,reperfusion time,systolic blood pressure,diastolic blood pressure,Killip classification,ST segment maximum elevation,one hour after PCI ST segment drop,pathological Q waveguide numbers.Collect patient test parameters: white blood cell count,neutrophil percentage,lymphocyte percentage,platelet count,mean platelet volume,platelet distribution width,creatinine,uric acid,creatine kinase,creatine kinase isoenzyme,hypersensitive troponin T,B-type natriuretic peptide precursor,fasting blood glucose,apolipoprotein A,apolipoprotein B,hypersensitive C-reactive protein,homocysteine,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein.Collect patient coronary angiography data: TIMI blood flow classification before PCI,PCI target vessel,collateral circulation,thrombosis,intraoperative maximum dilatation pressure,balloon dilatation time,numbers of pre-expansion,number of stent dilatation,numbers of posterior expansion,thrombus aspiration,IABP.Collect the postoperative MACE events: Postoperative AMI,hemodynamic instability to be re-operation,death during hospitalization.Select the appropriate statistical method to analyze the no-reflow group and normal blood group patients with all the data,determining whether there was a statistical difference or not.Obtain an independent risk factor for patients with acute STEMI who underwent emergency PCI for 12 hours.Results(1)In this study,there is a total of 113 patients with no-reflow(82 males and31 females)and 298 patients(230 males and 68 females)with normal flow.The probability of no-reflow phenomenon after PCI was 27.5%.(2)By comparing the basic clinical data,the results can be drawn.There were significant differences in incidence time,reperfusion time,systolic blood pressure,Killip classification,ST segment maximum elevation,one hour after PCI ST segment drop,pathological Q waveguide numbers.Others had no significant differences.(3)By comparing the test data,you can get the results.There were significant differences in white blood cell count,neutrophil percentage,lymphocyte percentage,creatine kinase,creatine kinase isoenzyme,hypersensitive troponin T,B-type natriuretic peptide precursor.Others had no significant differences.(4)By comparing the coronary angiography data,the results can be obtained.There were significant differences in TIMI blood flow classification before PCI,PCI target vessel,no collateral circulation,thrombosis,thrombus aspiration.Others had no significant differences.(5)By comparing postoperative MACE events,the results can be drawn.There was no AMI patients after PCI in both groups.There were no significant differences in hemodynamic instability to be re-operation,death during hospitalization.(6)Logistic regression analysis was used to analyze the results of all the data.The time of admission,reperfusion time,ST segment maximum elevation,pathological Q waveguide numbers,white blood cell count,neutrophil percentage,creatine kinase isoenzyme,hypersensitive troponin T,no collateral circulation are independent risk factors.Conclusions(1)The probability of no-reflow phenomenon after PCI was 27.5%.(2)incidence time,reperfusion time,systolic blood pressure,Killip classification,ST segment maximum elevation,one hour after PCI ST segment drop,pathological Q waveguide numbers,white blood cell count,neutrophil percentage,lymphocyte percentage,creatine kinase,creatine kinase isoenzyme,hypersensitive troponin T,B-type natriuretic peptide precursor,TIMI blood flow classification before PCI,PCI target vessel,no collateral circulation,thrombosis,thrombus aspiration have significant correlation with no-reflow phenomenon.(3)The time of admission,reperfusion time,ST segment maximum elevation,pathological Q waveguide numbers,white blood cell count,neutrophil percentage,creatine kinase isoenzyme,hypersensitive troponin T,no collateral circulation are independent risk factors for no-reflow in patients with acute STEMI after 12 hours of emergency PCI.(4)Reducing the reperfusion time can reduce the incidence of no-reflow phenomenon.