Analysis Of Risk Factors Associated With No-reflow In Emergency PCI In Patients With STEMI

Objective: To investigate the risk factors associated with no-reflow in patients with acute ST segment elevation myocardial infarction(SETMI)undergoing emergency PCI(Percutaneous Coronary Intervention),and to find a highly effective and rapid predictive factor for clinical guidance.Subjects and methods:The subjects of this study were 186 patients with STEMI who underwent coronary angiography and emergency PCI in the First Affiliated Hospital of South China University from June 1,2017 to May 31,2018,and met the criteria for selection and exclusion.According to the intraoperative TIMI blood flow classification,the patients were divided into two groups: normal reflow group(138 cases)and no-reflow group(48 cases).The clinical basic data,laboratory test results,and PCI results were compared.Binary logistic regression analysis was used to investigate the risk factors associated with no reflow after emergency PCI in patients with STEMI.The application of receiver operating characteristic curve(ROC curve)was used to analyze the optimal threshold and sensitivity and specificity of CLEC-2 for predictingno reflow in STEMI patients with emergency PCI.Result:1.A total of 186 patients with STEMI,including 128 males and 58 females,aged between 37 and 87 years,with an average age of 64.17±9.95 years.According to the presence or absence of no reflow,it is divided into two groups: the normal reflow group and the no-reflow group.There were 138 people in the reflow group,including 96 males and 42 females,aged 37-85 years,with an average age of 63.76±8.32 years.There were 48 patients in the no-reflow group,including 32 males and 16 females,aged 44-87 years,with an average age of 64.35±10.64 years.The basic data were compared between the two groups.Gender,age,diabetes,hypertension,TC,TG,NE,NLR were not statistically significant,while smoking,HDL-C,LDL-C,WBC,PLR,PLT,LY,and CLEC-2 were all statistically significant.2.Binary logsic analysis indicated no smoking in the reflow group(OR: 1.799,95% CI 1.019-3.225,P=0.049),CLEC-2(OR: 1.045,95% CI1.022-1.083,P=0.02),PLR(OR: 1.012,95% CI is 1.001-1.023,P=0.035),LDL-C(OR: 1.375,95% CI is 1.026-1.900,P=0.04),LY(OR: 1.382,95% CI is 1.115)-2.148,P=0.026)is the relevant risk prediction factor for no-reflow,and the greater the OR value,the stronger the correlation.Further multi-factor logistic regression analysis suggestssmoking,LDL-C,LY,PLR,CLEC-2 are independent predictors of no-reflow.3.ROC curve analysis showed that the area under the curve(AUC)of CLEC-2 predicting no-reflow in STEMI patients was 0.782,the confidence interval was 0.697-0.867.According to the Yoden index,the optimal cutoff point was 214.58,the sensitivity was 0.634,the specificity was 0.815,P<0.05,indicating that when the CLEC-2 value was >214.58pg/mL,the sensitivity of no-reflow phenomenon is 0.634,specificity is 0.815 and has the greatest value for predicting the occurrence of no reflow phenomenon.Conclusion:Independent risk factors associated with no-reflow in patients with STEMI in emergency PCI include: smoking,LDL-C,LY,PLR,CLEC-2,and high CLEC-2 values(>214.58 pg/mL)may be after emergency PCI in patients with STEMI independent predictor without reflow.