摘要
目的:探讨CHA_(2)DS_(2)-VASc评分对急性ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入(PPCI)治疗后无复流发生的预测价值。方法:选择2018年1月—2020年6月因STEMI就诊于江苏省苏北人民医院心内科行PPCI治疗的患者288例,依据术后TIMI血流分为无复流组(TIMI血流≤2级)49例、复流组(TIMI血流=3级)239例。收集两组患者的一般临床资料、实验室检查指标及手术相关信息,利用CHA_(2)DS_(2)-VASc评分系统进行评分。采用Logistic单因素及多因素回归分析PPCI术后无复流发生的独立危险因素,应用ROC曲线分析CHA_(2)DS_(2)-VASc评分预测无复流发生的最佳截点。结果:无复流组的CHA_(2)DS_(2)-VASc评分显著高于复流组(3.39±1.79∶1.97±1.51,P<0.001)。多因素Logistic回归分析显示,CHA_(2)DS_(2)-VASc评分是术后无复流发生的独立预测因子(OR=1.481,95%CI:1.200~1.828,P<0.001)。ROC曲线分析发现,CHA_(2)DS_(2)-VASc评分=3分为预测无复流发生的最佳截点(AUC=0.729,95%CI:0.651~0.806),特异性为66.5%,敏感性为71.4%。结论:CHA_(2)DS_(2)-VASc评分可作为一种有效预测STEMI患者PPCI术后无复流发生的评分工具,指导临床抗栓治疗方案选择,降低术后无复流的发生。
Objective:To explore the value of CHA_(2)DS_(2)-VASc score in predicting no-reflow in acute ST-segment elevation myocardial infarction(STEMI)patients after primary percutaneous coronary intervention(PPCI).Methods:Two hundred and eighty-eight STEMI patients who underwent PPCI in our hospital from January 2018 to June 2020 were divided into the no-reflow group(n=49)and control group(n=239)according to their TIMI blood flow.Clinical baseline information,laboratory examination,and PPCI related information were collected and CHA_(2)DS_(2)-VASc score was used to scoring.Independent risk factors of no-reflow after PPCI were analyzed by univariate and multivariate regression analysis.The receiver operating characteristic(ROC)curve was used to analyze the cut-off point of CHA_(2)DS_(2)-VASc score in predicting no-reflow.Results:The CHA_(2)DS_(2)-VASc score was significantly higher in the no-reflow group compared to the control group(3.39±1.79 vs 1.97±1.51,P<0.001).Multivariate Logistic regression analysis showed that the CHA_(2)DS_(2)-VASc score was an independent predictor of no-reflow after PPCI(OR=1.481,95%CI:1.200-1.828,P<0.001).ROC analysis revealed that CHA_(2)DS_(2)-VASc score=3 was the cut-off value for predicting no-reflow(AUC=0.729,95%CI:0.651-0.806),with a sensitivity of 71.4%and a specificity of 66.5%.Conclusion:CHA_(2)DS_(2)-VASc score could be used as a scoring tool to predict the occurrence of no-reflow after PPCI in STEMI patients,guide the strategy of antithrombotic therapy,and reduce the incidence of no-reflow after PCI.
作者
李小杜
何胜虎
LI Xiaodu;HE Shenghu(Department of Cardiology,Northern Jiangsu People’s Hospital,Yangzhou,Jiangsu,225001,China;The Second Clinical College of Dalian Medical University)
出处
《临床心血管病杂志》
CAS
北大核心
2021年第3期209-214,共6页
Journal of Clinical Cardiology
