[1]刘婷,潘文旭,何云,等.术前D-二聚体联合检测活化部分凝血活酶时间对急性冠脉综合征急诊PCI术中慢/无复流现象的预测价值[J].第三军医大学学报,2019,41(20):1982-1988.
 LIU Ting,PAN Wenxu,HE Yun,et al.Predictive value of preoperative D-dimer combined with activated partial thromboplastin time for slow/no-reflow phenomenon in emergency percutaneous coronary intervention[J].J Third Mil Med Univ,2019,41(20):1982-1988.
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术前D-二聚体联合检测活化部分凝血活酶时间对急性冠脉综合征急诊PCI术中慢/无复流现象的预测价值(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第20期
页码:
1982-1988
栏目:
临床医学
出版日期:
2019-10-30

文章信息/Info

Title:
Predictive value of preoperative D-dimer combined with activated partial thromboplastin time for slow/no-reflow phenomenon in emergency percutaneous coronary intervention
作者:
刘婷潘文旭何云成小凤何沛逊高志春晋军
陆军军医大学(第三军医大学)第二附属医院心血管内科
Author(s):
LIU Ting PAN Wenxu HE Yun CHEN Xiaofeng HE Peixun GAO Zhichun JIN Jun

Department of Cardiology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China

关键词:
D-二聚体活化部分凝血活酶时间急性冠脉综合征经皮冠状动脉介入治疗慢/无复流预测价值
Keywords:
D-dimer activated partial thromboplastin time acute coronary syndrome percutaneous coronary intervention no-reflow predictive value
分类号:
R446.1;R541.4;R543.3
文献标志码:
A
摘要:

目的 探讨D-二聚体(D-Dimer)联合活化部分凝血活酶时间(activated partial thromboplastin time,APTT)对急性冠状动脉综合征(acute coronary syndrome,ACS)患者行急诊经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)发生慢/无复流现象的预测价值。方法 分析2015年11月至2018年6月间陆军军医大学第二附属医院心血管内科就诊后拟行急诊PCI的ACS患者181例,术前检测所有患者的血浆D-二聚体、APTT等指标,根据TIMI血流分级方法将患者分为慢/无复流组和正常血流组,比较两组间D-二聚体和APTT与慢/无复流发生的相关性,并根据Cutoff值分为高危组和非高危组,比较两组慢/无复流发生率。结果 Logistics多因素回归分析显示本研究总人群中术前D-二聚体(OR=2.801,95%CI=1.399-5.610,P=0.004)和APTT(OR=0.881, 95%CI=0.810-0.959, P=0.003)分别与发生慢/无复流现象呈正相关和负相关,ROC曲线分析D-二聚体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),当D-二聚体联合APTT后AUC提高到0.697(95%CI=0.624-0.763,P<0.001)。根据D-二聚体和APTT的Cutoff值分组,高危组中慢/无复流的发生率较非高危组明显升高,分别为36.17%和14.92%(P=0.002)。结论 D二聚体越高,慢/无复流发生率越高,而术前活化部分凝血活酶时间与慢/无复流发生率呈负相关,联合检测D-二聚体和活化部分凝血活酶时间水平有助于预测ACS患者行急诊PCI术中慢/无复流现象的发生。

Abstract:

Objective To investigate the predictive value of D-dimer combined with activated partial thromboplastin time (APTT) for slow/no-reflow of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome(ACS). MethodsA total of 181 ACS patients undergoing emergency PCI in our department from November 2015 to June 2018 were recruited in this study. Their plasma D-dimer level and APTT were tested before surgery. According to thrombolysis in myocardial infarction (TIMI), the patients were divided into slow/no-reflow group and normal blood flow group. The correlations of D-dimer level and APTT were analyzed with the incidence of slow/no-reflow. According to the cutoff values of the 2 indicators, the patients were assigned into high-risk group and non-high-risk group, and the incidence of slow/no-reflow was compared between the 2 groups.  ResultsLogistics multivariate regression analysis showed preoperative D-dimer (OR=2.801, 95% CI=1.399~5.610, P=0.004) was positively, and APTT (OR=0.881, 95%CI=0.810~0.959, P=0.003) was negatively correlated with slow/no-reflow phenomenon. 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), and 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 values 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).  ConclusionHigher preoperative D-dimer indicates higher incidence of slow/no-reflow in ACS patients after emergency PCI, while preoperative APTT is negatively correlated with the incidence. So combined detection of the 2 indicators helps predict the occurrence of slow/no-reflow in the patients.

参考文献/References:

[1]KIMURA K, KIMURA T, ISHIHARA M, et al. JCS 2018 guideline on diagnosis and treatment of acute coronary syndrome[J]. Circ J, 2019, 83(5): 1085-1196. DOI:10.1253/circj.cj-19-0133.
[2]IBANEZ B, JAMES S, AGEWALL S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2018, 39(2): 119-177. DOI:10.1093/eurheartj/ehx393.
[3]吕海权. 冠脉介入术中无复流现象防治的研究进展[J]. 世界最新医学信息文摘, 2019, 19(45): 40-41. DOI:10.19613/j.cnki.1671-3141.2019.45.018.
LYU H Q. Research progress in prevention and treatment of No-reflow phenomenon in coronary intervention surgery[J]. World Latest Med Inf, 2019, 19(45): 40-41. DOI:10.19613/j.cnki.1671-3141.2019.45.018.
[4]ERKOL A, ODUNCU V, TURAN B, et al. The value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention and long-term prognosis in patients with acute ST segment elevation myocardial infarction[J]. J Thromb Thrombolysis, 2014, 38(3): 339-347. DOI:10.1007/s11239-013-1044-3.
[5]韩雅玲, 邓捷, 荆全民, 等.急性心肌梗死急诊介入治疗无再流发生的独立预测因素及对长期预后的影响[J].中华心血管病杂志, 2006, 34(6):483-486.
HAN Y L, DENG J, JING Q M, et al. Post primary percutaneous coronary intervention no-reflow in patients with acute myocardial infarction: contributing factors and long-term prognostic impact[J].Chin J Cardiol, 2006, 34(6):483-486.
[6]DONG-BAO L, QI H, ZHI L, et al. Predictors and long-term prognosis of angiographic slow/no-reflow phenomenon during emergency percutaneous coronary intervention for ST-elevated acute myocardial infarction[J]. Clin Cardiol, 2010, 33(12): E7-E12. DOI:10.1002/clc.20634.
[7]GIBSON C M, CANNON C P, MURPHY S A, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs[J]. Circulation,2000,101(2):125-130.DOI:10.1161/01.cir.101.2.125.
[8]ALIDOOSTI M, LOTFI R, LOTFI-TOKALDANY M, et al. Correlates of the “No-reflow” or “Slow-flow” phenomenon in patients undergoing primary percutaneous coronary intervention[J]. J Tehran Heart Cent, 2018, 13(3): 108-114.
[9]REZKALLA S H, KLONER R A. Coronary no-reflow phenomenon: from the experimental laboratory to the cardiac catheterization laboratory[J]. Catheter Cardiovasc Interv, 2008, 72(7): 950-957. DOI:10.1002/ccd.21715.
[10]YIP H K, CHEN M C, CHANG H W, et al. Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon[J]. Chest, 2002, 122(4): 1322-1332. DOI:10.1378/chest. 122.4.1322.
[11]NAGATA Y, USUDA K, UCHIYAMA A, et al. Characteristics of the pathological images of coronary artery thrombi according to the infarct-related coronary artery in acute myocardial infarction[J]. Circ J, 2004, 68(4): 308-314. DOI:10.1253/circj.68.308.
[12]KAUL S. The “no reflow” phenomenon following acute myocardial infarction: mechanisms and treatment options[J]. J Cardiol, 2014, 64(2): 77-85. DOI:10.1016/j.jjcc.2014. 03.008.
[13]HOU H C, GE Z J, YING P, et al. Biomarkers of deep venous thrombosis[J]. J Thromb Thrombolysis, 2012, 34(3): 335-346. DOI:10.1007/s11239-012-0721-y.
[14]ZHANG H Y, QIU B H, ZHANG Y, et al. The value of pre-infarction angina and plasma D-dimer in predicting No-reflow after primary percutaneous coronary intervention in ST-segment elevation acute myocardial infarction patients[J]. Med Sci Monit, 2018, 24: 4528-4535. DOI:10.12659/MSM.909360.
[15]NAPODANO M, RAMONDO A, TARANTINI G, et al. Predictors and time-related impact of distal embolization during primary angioplasty[J]. Eur Heart J, 2009, 30(3): 305-313. DOI:10.1093/eurheartj/ehn594.
[16]季亚娟, 丁晓梅. 冠心病患者凝血纤溶状态改变及其临床意义[J]. 心血管病学进展, 2009, 30(4): 646-648.
JI Y J, DING X M. Coagulation and fibrinolysis in patients with coronary heart disease and clinical significance of changes in state[J]. Adv Cardiovasc Dis, 2009, 30(4): 646-648.
[17]戴利亚, 李君, 张德亭. 急性冠脉综合征血浆抗凝血酶与凝血指标的检测及其临床意义[J]. 中国卫生检验杂志, 2011, 21(7): 1753-1754, 1756.
DAI L Y, LI J, ZHANG D T. The detection and clinical significances of plasma antithrombin and coagulation indexes in acute coronary syndrome[J]. Chin J Heal Lab Technol, 2011, 21(7): 1753-1754, 1756.
[18]中国医师协会急诊医师分会,中华医学会心血管病学分会,中华医学会检验医学分会. 急性冠脉综合征急诊快速诊疗指南[J]. 中华急诊医学杂志,2016,25(4):397-404. DOI: 10. 3760/cma. j. issn. 1671-0282. 2016. 04. 002.
Chinese Medical Association Emergency Physicians Branch, Chinese Society of Cardiology, Association of Laboratory Medicine, Chinese Medical Association. Guidelines for rapid emergency diagnosis and treatment of acute coronary syndrome[J]. Chin J Emerg Med, 2016,25(4):397-404. DOI: 10. 3760/cma. j. issn. 1671-0282. 2016. 04. 002.
[19]《中国经皮冠状动脉介入治疗指南(2016)》正式发布[J].中国介入心脏病学杂志,2016,24(6):315.
《China Percutaneous Coronary Intervention Therapy Guide (2016)》officially released[J]. Chin J Intervent Cardiol ,2016,24(6):315.
[20]ANTMAN E M, MCCABE C H, GURFINKEL E P, et al. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial[J]. Circulation, 1999, 100(15): 1593-1601. DOI:10.1161/01.cir.100.15.1593.
[21]ASHRAF T, KHAN M N, AFAQUE S M, et al. Clinical and procedural predictors and short-term survival of the patients with no reflow phenomenon after primary percutaneous coronary intervention[J]. Int J Cardiol, 2019: S0167-S5273(19)32691-9. DOI:10.1016/j.ijcard.2019.07.067.
[22]DEL TURCO S, BASTA G, DE CATERINA A R, et al. Different inflammatory profile in young and elderly STEMI patients undergoing primary percutaneous coronary intervention (PPCI): Its influence on no-reflow and mortality[J]. Int J Cardiol, 2019, 290: 34-39. DOI:10.1016/j.ijcard. 2019.05.002.
[23]TASAR O, KARABAY A K, ODUNCU V, et al. Predictors and outcomes of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J]. Coron Artery Dis, 2019, 30(4): 270-276. DOI:10.1097/MCA.0000000000000726.
[24]ZHANG X Y, SUN Y, YANG X Y, et al. Effect of Chinese medicine on No or slow reflow after percutaneous coronary intervention in myocardial infarction patients: A systematic review and meta-analysis[J]. Chin J Integr Med,2019. DOI: 10.1007/s11655-019- 2703-9.
[25]NDREPEPA G, COLLERAN R, KASTRATI A. No-reflow after percutaneous coronary intervention: a correlate of poor outcome in both persistent and transient forms[J]. EuroIntervention, 2018, 14(2): 139-141. DOI:10. 4244/EIJV14I2A21.
[26]JAFFE R, CHARRON T, PULEY G, et al. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention[J]. Circulation, 2008, 117(24):3152-3156.DOI:10.1161/CIRCULATIONAHA.107.742312.
[27]TOPRAK C, TABAKCI M M, SIMSEK Z, et al. Platelet/lymphocyte ratio was associated with impaired myocardial perfusion and both in-hospital and long-term adverse outcome in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention[J]. Adv Interv Cardiol, 2015, 11(4): 288-297. DOI:10.5114/pwki. 2015.55599.
[28]WANG Z, REN L H, LIU N, et al. Association of monocyte count on admission with angiographic no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction[J]. Kardiol Pol, 2016, 74(10): 1160-1166. DOI:10.5603/KP. a2016.0065.
[29]IWAKURA K, ITO H, KAWANO S, et al. Predictive factors for development of the no-reflow phenomenon in patients with reperfused anterior wall acute myocardial infarction[J]. J Am Coll Cardiol, 2001, 38(2): 472-477. DOI:10.1016/s0735-1097(01)01405-x.
[30]GAO R H, WANG J J, ZHANG S H, et al. The value of combining plasma D-dimer and endothelin-1 levels to predict No-reflow after percutaneous coronary intervention of ST-segment elevation in acute myocardial infarction patients with a type 2 diabetes mellitus history[J]. Med Sci Monit, 2018, 24: 3549-3556. DOI:10.12659/MSM.908980.
[31]SARLI B, AKPEK M, BAKTIR A O, et al. Impact of D-dimer level on postinterventional coronary flow and in-hospital MACE in ST-segment elevation myocardial infarction[J]. Herz, 2015, 40(3): 507-513. DOI:10.1007/ s00059-013-4029-2.
[32]张卫君, 胡铂. 血浆D-二聚体水平对急性ST段抬高型心肌梗死经皮冠状动脉介入治疗术中无复流的预测价值[J]. 上海医学, 2019, 42(2): 65-69.
ZHANG W J, HU B. Predictive value of plasma D-dimer level for no-flow after primary percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction[J]. Shanghai Med J, 2019, 42(2): 65-69.
[33]GOLINO P, RAGNI M, CIRILLO P, et al. Recombinant human, active site-blocked factor VIIa reduces infarct size and no-reflow phenomenon in rabbits[J]. Am J Physiol Heart Circ Physiol, 2000, 278(5): H1507-H1516. DOI:10.1152/ajpheart.2000.278.5.H1507.
 

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更新日期/Last Update: 2019-10-25