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Abstract：
The high thrombus burden of the infarct-related artery (IRA) is associated with the adverse prognosis in ST-segment elevation myocardial infarction (STEMI) patients. Our objectives were to investigate the predictors and evaluate the prognosis of refractory thrombus in STEMI patients. A total of 1305 consecutive patients with STEMI who underwent primary percutaneous coronary intervention (pPCI) were screened. The refractory thrombus group (n = 15) was defined as IRA thrombolysis in myocardial infarction flow < grade 2 after multiple thrombus aspiration (TA). The control group (n = 45) was age- and sex-matched and was selected from the same batch of patients. Baseline hematologic indices were measured before the pPCI. The major adverse cardiovascular events (MACE) were recorded during follow-up. The refractory thrombus group had significantly higher red cell distribution width (RDW) at baseline compared with the control group (13.1 [12.4-13.7] vs 12.6 [12.3-12.8], P = .008). In multivariate logistic regression analysis, RDW was an independent predictor of refractory thrombus (odds ratio: 8.799, 95% CI: 1.240-62.454, P = .030). The area under the receiver-operating characteristic curve of the RDW was 0.730 (95%CI: 0.548-0.912, P = .008). During a mean period of 26 months follow-up, patients in the refractory thrombus group tended to have higher percent MACEs compared with patients in the control group (53.3% vs 6.7%, P < .001). In the present study, we found that the refractory thrombus in STEMI patients was associated with the worse prognosis and the increased RDW might be a potential independent predictor.
摘要：
梗死相关动脉（IRA）的高血栓负荷与ST段抬高型心肌梗死（STEMI）患者的不良预后相关。我们的目的是研究STEMI患者难治性血栓的预测因素并评估其预后。共筛选了1305例接受直接经皮冠状动脉介入治疗（pPCI）的STEMI连续患者。难治性血栓组（n=15）定义为多次血栓抽吸（TA）后心肌梗死血流<2级的IRA溶栓。对照组（n=45）年龄和性别匹配，并从同一批患者中选择。在pPCI之前测量基线血液学指标。随访期间记录主要不良心血管事件（MACE）。与对照组相比，难治性血栓组基线时红细胞分布宽度（RDW）明显更高（13.1[12.4-13.7]vs12.6[12.3-12.8]，P=.008）。在多变量逻辑回归分析中，RDW是难治性血栓的独立预测因子(比值比:8.799,95%CI:1.240-62.454,P=.030)。RDW的受试者工作特征曲线下面积为0.730（95CI：0.548-0.912，P=.008）。在平均26个月的随访期间，与对照组患者相比，难治性血栓组患者的MACEs百分比较高(53.3%vs6.7%,P<.001)。在本研究中,我们发现STEMI患者的难治性血栓与不良预后相关,而RDW升高可能是一个潜在的独立预测因子.
