| Objective: In patients with acute myocardial infarction who have been subjected to percutaneous coronary intervention(PCI)reperfusion therapy,the optimal blood flow may not be restored to the patient or the flow filling rate is slow,a situation referred to as a no reflow /slow flow.Although more is known about the pathophysiological mechanism of no-reflow/slow flow after PCI and its prevention and treatment,the incidence of noreflow/slow flow was still high.When no reflow/slow flow occurs after PCI,the risk of cardiogenic shock,malignant arrhythmia,acute dyspnea due to heart failure,and persistent chest pain is increased.Therefore,early detection,early prevention and early treatment with no reflow/slow flow are particularly important in the prognosis of patients after PCI.However,hospitalized outcomes in elderly patients with acute ST-elevation myocardial infarction(STEMI)are poorly investigated as a risk factor for reperfusion after PCI.Therefore,this study focused on the risk factors of no-reflow/slow flow after PCI in elderly patients with acute STEMI and the prognosis in hospital,aiming to provide a new way of thinking for clinical practice,so as to reduce the occurrence of noreflow/slow flow,further lowering the complications can finally enhance the clinical prognostic survival rate of patients.Methods: 307 elderly patients with acute STEMI who underwent emergency coronary angiography in Northern Jiangsu People’s Hospital from September 2016 to March 2020 were selected.According to the TIMI blood flow grade after PCI,245 patients in the normal flow group(TIMI level 3)and 62 patients in the no-reflow/slow flow group(TIMI<level 3)were selected.General clinical data including hospital medication history and Major adverse cardiovascular events(MACEs)were collected.Heart rate and blood pressure were measured before emergency coronary angiography,and shock index was calculated.Heart rate and blood pressure were measured at least 3times,1-2min interval,and the mean value was calculated.Shock index = heart rate/systolic pressure.Before emergency coronary angiography,5ml of venous blood was extracted from all patients,and routine blood tests were performed according to the standard of laboratory medicine department of Jiangsu North People’s Hospital.Using SPSS23.0 statistical software,using x±s to represent the normal distribution of data,using the independent sample t-test,with M(Q1,Q3)to represent the non-normal distribution data,expressed in percentage to count data,using X2 test and the Mann-Whitney U test,Significant variables from univariate analysis were included in multivariate logistic regression analysis,and relevant factors were corrected,step by step analysis in patients with acute STEMI PCI risk factors of postoperative no reflow/slow flow,ROC curve evaluation of PCI postoperative no reflow/slow flow risk factors related to value,P<0.05 was considered statistically significant.Results: The age and systolic blood pressure of the no-reflow/slow-flow group were lower than the normal blood flow group,and the proportion of blood glucose,heart rate,shock index and TIMI blood < grade 3 before PCI was higher than the normal blood flow group(P<0.05).There were differences in the incidence of recurrent myocardial infarction and MACEs between the two groups(P<0.05).Univariate analysis revealed that age,systolic blood pressure,shock index,TIMI blood flow < grade 3 before PCI,and blood glucose were associated with no reflow/slow flow after acute STEMI(P<0.05).Multivariate logistic regression analysis showed that shock index,TIMI blood flow <level 3 before PCI,and blood glucose in patients with acute STEMI after surgery with no reflow/slow flow had certain independent predictive value(OR=99.127,95%CI:6.039～1627.095,P=0.001;OR = 12.087,95% CI: 2.802 ～ 5.149,P= 0.001;OR = 1.090,95% CI: 1.017 ～ 1.167,P = 0.014).ROC curve analysis revealed that the area under the curve of shock index for predicting the occurrence of no reflow/slow flow in patients with acute STEMI after PCI was 0.668(95%CI: 0.595～0.740,P<0.01),the diagnostic cut-off value was 0.595,the sensitivity was 74.2%,and the specificity was 55.1%.The area under the curve for blood glucose to predict no reflow/slow flow after PCI in patients with acute STEMI was 0.606(95%CI: 0.528-0.684,P<0.01),with a diagnostic cut-off of 6.185,a sensitivity of 71.0% and a specificity of50.6%.Conclusions:1.There is a certain correlation between shock index,TIMI blood flow < level 3before PCI,blood glucose and no reflow/slow flow after PCI in elderly patients with acute STEMI;2.Shock index and blood glucose are relatively easy to obtain indicators in clinical practice,and there is certain clinical guiding value in the occurrence of no reflow/slow flow in elderly patients with acute STEMI after PCI;3.There is a high incidence rate of MACEs in elderly patients with acute STEMI after PCI with no reflow/slow flow and poor clinical prognosis. |
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