Prognostic Value Of Coagulation Function For Slow/no-reflow Phenomenon In Patients With Acute Coronary Syndrome In Emergency Percutaneous Coronary Intervention

BackgroundNowadays the mortality rate of cardiovascular disease is increasing year by year.The proportion of deaths of more than 40% ranks first among the deaths of residents,which is higher than that of cancer and other diseases.Acute coronary syndrome(ACS)is a common and high-risk type of cardiovascular disease,including unstable angina(UA),non-ST-segment elevation myocardial infarction,and ST-segment elevation myocardial infarction.Percutaneous coronary intervention(PCI)is currently the most important treatment for ACS.However,the incidence of major adverse cardiovascular events(MACE)in patients after PCI remains to be explored.Current studies have shown that risk factors such as coagulation status after hypertension,hypertension,diabetes and smoking are associated with prognosis.In the past few years,the clinical management of patients with ACS has improved and the prognosis has improved significantly.However,the incidence of ischemic complications such as reinfarction after PCI and stent thrombosis remains high.Slow/no-reflow of coronary arteries is one of the major complications in emergency PCI,and slow/no-reflow is associated with major adverse cardiovascular events(MACE).At present,there is limited understanding of the mechanism of slow/no-reflow,which may be related to microthrombosis embolism,microvascular structural changes,inflammatory stimulation,ischemic injury,reperfusion injury,microvascular mechanical injury,coagulation cascade.In addition to unstable coronary atherosclerotic plaques,coagulation disorders during reperfusion may cause hypercoagulability in the body,which also plays an important role in the development of ACS and ischemic complications.Therefore,the selection of blood markers that reflect hypercoagulable state is of great significance for the assessment of the patient's severity and prognosis.ObjectivesTo investigate the coagulation function such as D-Dimer and Activated partial thromboplastin time(APTT)in patients with acute coronary syndrome(ACS)and emergency percutaneous coronary intervention.To explore the predictive value of coagulation function for slow/no-reflow in patients with acute coronary syndrome undergoing PCI.Provide guidance on the future research on the related mechanisms of coagulation system and the correlation between slow/no reflow.MethodsContinuous referral 227 patients with acute coronary syndrome who were diagnosed with ACS after emergency cardiology in the Department of Cardiology,Xinqiao Hospital,Army Medical University from November 2015 to June 2018.According to the inclusion and exclusion criteria,181 patients who met the inclusion criteria were selected.Preoperative detection of plasma D-dimer,APTT and other indicators in all patients.Patients were divided into a slow/no-reflow group and a normal blood flow group according to the TIMI blood flow classification method.Comparing the correlation between D-dimer,APTT and other indicators in two group.And calculate the Cutoff value according to the ROC curve.The total population was divided into high-risk groups and non-high-risk groups by Cutoff values.The incidence of slow/no reflow was compared between the two groups.Results1.There were 227 patients with acute coronary syndrome who underwent emergency PCI,including 178 males and 49 females.Among them,1 case was excluded by coronary artery bypass grafting according to the exclusion criteria,1 case was complicated with cardiomyopathy,5 cases were severe anemia,12 cases were severe liver and kidney dysfunction,3 cases were malignant tumor history,3 cases were after thrombolysis,and the situation was urgent or bypassed.The patients in the emergency department chest pain center did not complete the blood test in 21 cases,the total exclusion of 46 cases,and finally met the inclusion criteria of 181 cases,37 cases of slow/no-reflow phenomenon in PCI,and 144 cases of normal blood flow.2.Collect and record general clinical data for selected cases,including age,gender,systolic blood pressure,diastolic blood pressure,heart rate,smoking history,history of hypertension,history of diabetes,etc.Collect and record biochemical indicators of selected cases,including cardiac troponin I(TNT-I),CK-MB,brain natriuretic peptide(BNP),blood routine,glomerular filtration rate,blood lipids,C-reactive protein,D-dimer,international normalized ratio,thrombin time,activated part Thromboplastin time,fibrinogen,antithrombin III,etc.Compare the differences between the general clinical data and biochemical indicators in the two groups.Through logistic regressive analysis,clarify the effect of coagulation function on slow/no-reflow phenomenon.3.Logistics multivariate regression analysis showed preoperative D-dimer(OR=2.801,95% CI=1.399-5.610,P=0.004)and APTT(OR=0.881,95%CI=0.810-0.959,P=0.003)in the total population of the study.Positively and negatively correlated with slow/no-reflow phenomenon,respectively.According to ROC curve,D-dimer AUC=0.612(95% CI=0.537-0.683,P=0.036),APTT AUC=0.653(95% CI=0.579-0.722,P=0.004),AUC increased to 0.697(95% CI=0.624-0.763,P<0.001)when D-dimer was combined with APTT index.According to the Cutoff value grouping of D-dimer and APTT,the incidence of slow/no-reflow in high-risk and non-high-risk groups was 36.17% and 14.92%,respectively(P=0.002).Conclusions1.D-dimer is positively correlated with the incidence of slow/no reflow.The higher the preoperative activation of partial thromboplastin,the lower the incidence of slow/no reflow.2.Combined detection of D-dimer and activated partial thromboplastin time levels can help predict the occurrence of slow/no-reflow in patients with ACS undergoing emergency PCI.3.This study screened D-dimer and APTT before PCI,which helps us identify high-risk groups with intraoperative slow/no-reflow events before surgery.It has important guiding significance for helping clinicians to judge whether to use drugs to prevent the incidence of slow/no reflow.