关键词: 心肌梗死, 经皮冠状动脉介入治疗, 无复流现象, 影响因素分析, 甘油三酯-总胆固醇-体质量指数

Abstract:

Objective To investigate the association between the triglyceride-cholesterol-body mass index (TCBI) and intraoperative slow-flow/no-reflow (SR/NR) phenomenon during emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods A total of 557 patients diagnosed with AMI and treated with emergency PCI from January 2020 to December 2022 were selected and divided into the SR/NR group (TIMI 0-2 grade, 188 cases) and the normal blood flow group (TIMI 3 grade, 369 cases) based on the TIMI blood flow grade during PCI. The TCBI was calculated and its natural logarithm (LnTCBI) was taken to meet the normality requirement. Patients were grouped by the tertiles of LnTCBI: Q1 group (LnTCBI < 6.97, 186 cases), Q2 group (6.97 ≤ LnTCBI < 7.62, 185 cases) and Q3 group (LnTCBI ≥ 7.62, 186 cases). Baseline data of patients were collected, and differences between groups were compared. Multivariate Logistic regression was used to analyze the influencing factors of SR/NR, and patients were subgrouped based on age, smoking, hypertension, extensive anterior wall myocardial infarction and high thrombotic burden (HTB). The association between LnTCBI and SR/NR in each subgroup was analyzed. The robustness was verified by restricted cubic spline (RCS). The diagnostic efficacy of LnTCBI for SR/NR was evaluated by receiver operating characteristic curve (ROC). Results Compared with the group of normal blood flow, the SR/NR group showed lower age, higher usage rate of intra-aortic balloon counterpulsation, higher thrombus burden (HTB), higher incidence of cardiac arrest and malignant arrhythmia, higher Killip grade Ⅱ, Killip grade Ⅲ-Ⅳ, higher usage rate of clopidogrel, higher white blood cell count (WBC), absolute neutrophil count, platelet count (PLT), triglycerides, serum creatinine (Scr), urea nitrogen, blood uric acid, LnTCBI level, higher absolute lymphocyte count (ALC), and decreased systolic blood pressure, diastolic blood pressure, left ventricular ejection fraction level, usage rate of beta-blockers, ticagrelor and angiotensin-converting enzyme inhibitors/angiotensin II receptor antagonists (P<0.05). The trend test analysis showed that from the Q1 group, Q2 group to Q3 group, the incidence rates of T2DM, dyslipidemia and SR/NR in patients showed an increasing trend (P<0.05). Linear regression analysis indicated that the levels of WBC, ALC, PLT and Scr showed an increasing trend (P<0.05). Multivariate Logistic regression analysis showed that regardless of LnTCBI as a continuous variable or a three-category variable, high LnTCBI was independently associated with an increased risk of SR/NR. The model discrimination C index was 0.820 (0.786 - 0.865, P<0.01). Hosmer-Lemeshow goodness-of-fit test, χ²=5.820, P = 0.667, indicated a good model fit. RCS analysis showed that LnTCBI had a non-linear dose-response relationship with the risk of SR/NR (P _non-linear = 0.036), the inflection point value was 6.948 (95%CI: 6.921 - 6.974). Subgroup analysis showed that in different age groups, without hypertension, with and without acute extensive anterior wall myocardial infarction and HTB subgroups, LnTICB≥7.62 was a risk factor for patients to develop SR/NR (P<0.05). In the smoking population, LnTICB<6.97 and LnTICB≥7.62 were risk factors for patients to develop SR/NR (P<0.05). ROC curve analysis showed that the area under the curve of LnTCBI for predicting severe complications was 0.628, sensitivity was 62.8%, specificity was 53.1%, and the optimal diagnostic cutoff value was 7.223. Conclusion LnTCBI elevation is closely related to the increased risk of SR/NR during PCI in AMI patients, and which can be used as a biomarker for early identification of high-risk populations.

Key words: myocardial infarction, percutaneous coronary intervention, no-reflow phenomenon, root cause analysis, triglyceride-total cholesterol-body mass index