STUDY ON RISK FACTORS OF PREOPERATIVE POOR CORONARY BLOOD FLOW PERFUSION IN STEMI PATIENTS UNDERGOING INTERVENTIONAL SURGERY

Objective: To explore the risk factors of preoperative poor coronary blood flow perfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing interventional surgery. Method: This study included 317 patients with STEMI who underwent interventional surgery in our hospital from January 2016 to March 2021. According to the blood flow classification (TIMI) of patients with myocardial infarction after thrombolysis, the patients were divided into good perfusion group (grade 0-1) and poor perfusion group (grade 2-3). The general data, coronary angiography results and optical coherence tomography (OCT) data of the two groups were compared, and the independent risk factors of preoperative poor coronary perfusion were evaluated by multi-factor method. Results: The age, levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high sen-sitivity C-reactive protein (hs-CRP) in poor perfusion group were significantly higher than those in good perfusion group (P<0.05). The left ventricular ejection fraction (LVEF) and cardiac troponin I (cTnI) levels in poor perfusion group were significantly lower than those in good perfusion group (P<0.05). The proportion of right coronary artery involvement, diameter stenosis degree, infarction-related artery lesion length, proportion of plaque rupture, proportion of lipid plaque, blood flow area stenosis degree, lipid-rich plaque ratio, proportion of atherosclerotic plaque with thin fibrous cap, lipid angle, maximum lipid angle, proportion of macrophage aggregation and proportion of cholesterol crystallization in poor perfusion group were significantly higher than those in good perfusion group (P<0.05). The proportion of left anterior descending coronary artery involvement, minimum lumen diameter, proportion of plaque erosion and minimum blood flow area in poor perfusion group were significantly smaller than those in good perfusion group (P<0.05). The result of multivariate Logistic regression model showed that hs-CRP level >3.4mg/l, lesion length >17mm, lipid angle >258 degrees and cholesterol crystallization were independent risk factors of poor coronary perfusion before operation (P<0.05). Conclusion: The poor coronary blood flow perfusion of STEMI patients before interventional therapy is closely related to the decrease of plaque stability and hyperinflammatory reaction.