| Background:About 12% to 30% of patients with acute ST segment elevation myocardial infarction have slow flow / no reflow phenomenon after percutaneous coronary intervention,and the prognosis of these patients is poor.Some studies have shown that microvascular obstruction caused by intracoronary thrombosis,distal embolism,lowgrade inflammation and microvasospasm are the possible mechanisms of noreflow.Residual lipoprotein cholesterol is a newly proposed index and an independent risk factor for coronary atherosclerotic heart disease.In addition,it has been shown to be associated with low-grade coronary inflammation and is a predictor of poor prognosis in patients with acute coronary syndrome.Objective:The purpose of this study was to investigate the relationship between serum residual lipoprotein cholesterol and slow blood flow / no reflow after primary percutaneous coronary intervention and short-term prognosis in patients with acute ST segment elevation myocardial infarction.Methods:Patients with acute ST segment elevation myocardial infarction who underwent emergency percutaneous coronary intervention in the Department of Cardiology,Subei people’s Hospital of Jiang Su Province from October 2016 to September 2019 were selected.After admission,the general conditions of patients such as age and sex,past medical history of hypertension,diabetes,hyperlipidemia and smoking,as well as prehospital time,first medical contact-balloon dilatation time,target vessels and other emergency percutaneous coronary intervention therapy indexes were recorded.Except for those who persisted in taking antiplatelet drugs for a long time,all patients were given intensive antiplatelet therapy with loaded aspirin 300 mg and ticagrelor 180 mg before operation.All patients were treated with standard PPCI.Fasting blood lipids were analyzed in all patients on the second day after admission,and RLP-c used the formula RLP-c=TCHDL-c-LDL-c).During the 24-month follow-up,the incidence of MACEs was recorded,and all the data were analyzed by SPSS17.0 statistical software,and the difference between the two groups was considered to be statistically significant.Results:1.A total of 260 patients were included,according to the presence or absence of postoperative slow flow / no reflow(CSF/CNR),the patients were divided into normal flow group((NCF)group,n = 221)and CSF/CNR group(mean age: 66.00(55.00,73.00),CSF/CNR=36/3,male / female = 30,n = 9)and normal flow group(mean age: 62.00,male / female = 180 ml,n = 31)and CSF/CNR group(n = 39,male / female = 30).2.Taking the postoperative coronary blood flow as the dependent variable and RLPc as the independent variable,the ROC curve was drawn.It was suggested that the area under the ROC curve was 0.650(95% CI:0.555,0.746,P = 0.003).The best critical point for RLP-c to judge the occurrence of CSF/CNF in STEMI patients receiving PPCI is 0.695mmol/L(sensitivity: 66.7%,specificity: 56.1%).3.According to the results of ROC curve,the selected patients were divided into two groups: RLP-L group(RLP-c < 0.6950 mmol memory n = 137cases)and RLP-H group(RLP-c ≥ 0.6950 mmol line n = 123cases).The analysis of general data showed that the age and HDL-c in RLP-H group were lower than those in RLP-L group(P = 0.037,P < 0.001),while the incidence of BMI,CSF/CNR,TG,TC and LDL-c in RLP-L group were higher than those in RLP-L group(BMI:P = 0.010,other indexes P < 0.001).4.Follow-up Maces event analysis:The average follow-up time of the two groups was 12(6,24)months.There were 25 cases of Maces events,including 19 cases of all-cause death(17 cases of cardiogenic death,1 case of stroke,1 case of respiratory failure),2 cases of recurrent myocardial infarction,3 cases of unstable angina pectoris and 2 cases of heart failure.16 cases of Maces events occurred in the NCF group(12 cases died of all causes),and 9 cases of Maces events occurred in the CSF/CNR group(6 cases died of all causes),and the difference between the groups was statistically significant(23.1% vs 7.2%,P = 0.005).The results of Kaplan-Meier survival curve also showed that the prognosis of CSF/CNR group was significantly worse than that of NCF group,and the difference was statistically significant((Log Rank = 9.163,P = 0.002).2.7 cases of Maces events occurred in the RLP-L group(6 cases died of all causes),and 18 cases of Maces events occurred in the RLP-H group(12 cases died of all causes).The difference between the groups was statistically significant(14.6% vs 4.4% P = 0.009).The results of Kaplan-Meier survival curve also showed that the prognosis of RLPH group was significantly worse than that of RLP-L group,and the difference was statistically significant((Log Rank = 7.120,P = 0.008).3.According to the boundary of LDL-c 2.6mmol/L,the patients were divided into < 2.6mmol/L group and ≥ 2.6mmol/L group.Kaplan-Meier survival curve was used in each group.The results showed that in LDL-c < 2.6mmol/L group,the prognosis of RLP-H group was significantly worse than that of RLP-L group,and the difference was statistically significant((Log Rank = 9.104,P = 0.003).In the group of LDL-c ≥ 2.6mmol/L,the prognosis of RLP-H group was similar to that of RLP-L group,and the difference was not statistically significant((Log Rank = 0.448,P = 0.503).4.COX univariate regression analysis of the baseline data of all patients showed that except for HDL-c,intracoronary administration and CSF/CNR,other factors did not enter the regression equation,and there was no statistical significance.The results of multivariate COX regression analysis showed that after correcting HDL-c and RLP-c,postoperative CSF/CNR was an independent risk factor for Maces events in STEMI patients who received PPCI [HR:0.299,95%CI(0.132),P = 0.019)].5.In LDL-c < 2.6mmol/L group,COX univariate regression analysis showed that TG,RLP-c and postoperative CSF/CNR were possible risk factors.After adjusting for postoperative CSF/CNR,higher RLP-c was an independent risk factor for Maces events in STEMI patients who received PPCI [HR:4.314,95%CI(1.166)15.965),P = 0.029].Conclusions:1.Higher RLP-c level may be an effective predictor of CSF/CNF in patients with STEMI after PPCI.2.Postoperative CSF/CNF is an independent risk factor for out-of-hospital Maces events in patients with STEMI after PPCI.The incidence of Maces events was lower in patients with higher HDL-c levels,but it was not an independent protective factor.3.The incidence of out-of-hospital Maces events in patients with RLP-c ≥ 0.695mmol/L was significantly higher than that in patients with < 0.695mmol/L,but the increase of RLP-c could not be proved to be an independent risk factor.4.In the patients with LDL-c < 2.6mmol/L receiving STEMI after PPCI,after correcting the postoperative CSF/CNF,the increased RLP-c may be an independent risk factor for out-of-hospital Maces events. |
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