Abstract:

Objective　To evaluate the prognostic value of Canada Acute Coronary Syndrome (C-ACS) risk score for no reflow or slow flow in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods　One hundred and twenty-one patients diagnosed with STEMI who received PCI in No.215 Hospital of Shaanxi Nuclear Industry from January 2022 to April 2023 were included. There were 87 males and 34 females, with an average age of 67.4 years old. The patients were divided into two groups according to whether combined with no-reflow/slow flow, and the clinical data of the two groups were compared. Logistic regression analysis was used to find the influencing factors of no reflow/slow flow in STEMI patients after PCI. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of C-ACS risk score for no reflow/slow flow in STEMI patients after PCI. Independent sample t test and χ² test were used. Results　Age, male, smoking, serum creatinine level, Global Registry of Acute Coronary Events (GRACE) score, and C-ACS risk score in the no-reflow/slow flow group were significantly higher than those in the normal flow group, with statistically significant differences (all P<0.05). Logistic regression analysis showed that age, GRACE score, C-ACS risk score, male, and smoking were all risk factors for no-reflow/slow flow in STEMI patients after PCI (all P<0.05). The sensitivity, specificity, and area under the curve (AUC) of C-ACS risk score for predicting no-reflow/slow flow in STEMI patients after PCI were 72.9%, 75.3%, and 0.783; the sensitivity, specificity, and AUC of C-ACS risk score combined with GRACE score in predicting no-reflow/slow flow in STEMI patients after PCI were 70.8%, 86.3%, and 0.844. The specificity and AUC of C-ACS risk score combined with GRACE score in predicting no-reflow/slow flow in STEMI patients after PCI were higher than those of single indicator. Conclusions　C-ACS risk score has a high predictive value for no-reflow/slow flow in STEMI patients after PCI. The C-ACS risk score combined with GRACE score has a higher specificity in predicting no reflow/slow flow in STEMI patients after PCI.

Key words:

Canada Acute Coronary Syndrome risk score, Percutaneous coronary intervention, ST-segment elevation myocardial infarction, No reflow or slow flow

摘要：

目的　评估加拿大急性冠状动脉综合征（Canada Acute Coronary Syndrome，C-ACS）风险评分对ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）术后无复流或慢血流的预测价值。方法　纳入2022年1月至2023年4月就诊于陕西省核工业二一五医院接受PCI的STEMI患者共计121例，其中男87例，女34例，平均年龄67.4岁。依照是否合并无复流/慢血流进行分组，对比两组患者临床资料。采用logistic回归分析寻找STEMI患者PCI术后无复流或慢血流的影响因素。使用受试者操作特征曲线（ROC）评估C-ACS风险评分对STEMI患者PCI术后无复流或慢血流的预测价值。采用独立样本t检验、χ²检验。结果　无复流/慢血流组患者年龄、男性占比、吸烟率、血肌酐水平以及全球急性冠状动脉事件注册（Global Registry of Acute Coronary Events，GRACE）评分、C-ACS风险评分均明显高于正常血流组，差异均有统计学意义（均P<0.05）。年龄增长、GRACE评分升高、C-ACS风险评分升高、男性、吸烟均为影响STEMI患者PCI术后无复流或慢血流的危险因素（均P<0.05）。C-ACS风险评分预测STEMI患者PCI术后无复流或慢血流的灵敏度为72.9%，特异度为75.3%，曲线下面积（AUC）为0.783；C-ACS风险评分联合GRACE评分预测STEMI患者PCI术后无复流或慢血流的灵敏度为70.8%，特异度为86.3%，AUC为0.844；C-ACS风险评分联合GRACE评分预测STEMI患者PCI术后无复流或慢血流的特异度和AUC高于单一指标。结论　C-ACS风险评分对STEMI患者PCI术后无复流或慢血流具有较高的预测价值。C-ACS风险评分联合GRACE评分预测STEMI患者PCI术后无复流或慢血流具有更高的特异度。

关键词:

加拿大急性冠状动脉综合征风险评分, 经皮冠状动脉介入治疗, ST段抬高型心肌梗死, 无复流或慢血流