冠状动脉侧支循环对老年急性ST段抬高型心肌梗死患者预后的影响  

Eff ects of coronary collateral circulation on prognosis among elderly patients with acute ST-segment elevation myocardial infarction

作　　者：刘国勇 孟晓雪[3] 苏晓灵[2] 李文强[2] 张钲[3] LIU Guo-yong;MENG Xiao-xue;SU Xiao-ling;LI Wen-qiang;ZHANG Zheng(Department of Cardiovascular Clinical Medicine Center,Liyuan Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430077,China)

机构地区：[1]华中科技大学同济医学院附属梨园医院心血管临床医学中心,湖北武汉430077 [2]青海省人民医院心内科 [3]兰州大学第一医院心脏中心

出　　处：《中国介入心脏病学杂志》2020年第6期321-327,共7页Chinese Journal of Interventional Cardiology

基　　金：青海省科学技术厅基础研究计划项目(2019-ZJ-7039)。

摘　　要：目的探讨冠状动脉侧支循环对冠状动脉急性闭塞且成功进行直接经皮冠状动脉介入治疗(PCI)的老年急性ST段抬高型心肌梗死(STEMI)患者全因死亡的影响。方法回顾性入选346例STEMI合并急性冠状动脉完全闭塞且行直接PCI成功的老年患者,根据Rentrop分级水平分为冠状动脉侧支循环不良组(Rentrop 0~1级)和冠状动脉侧支循环良好组(Rentrop 2~3级),共随访12个月。采用logistic回归分析冠状动脉侧支循环不良是否是心肌呈色分级(MBG)3级、Killip心功能分级≥Ⅱ级、使用主动脉内球囊反搏(IABP)的独立预测因素;采用Log-Rank时序检验筛选对死亡有影响的因素;采用Cox回归分析识别对死亡有明显影响的因素。结果logistic多因素回归分析发现,冠状动脉侧支循环不良是Killip心功能分级≥Ⅱ级(OR 0.210,95%CI 0.061~0.724,P=0.013)、使用IABP(OR 0.272,95%CI 0.092~0.805,P=0.019)及MBG 3级(OR 4.554,95%CI 2.148~9.655,P<0.001)的独立影响因素;随访12个月,失访52例(15.0%),死亡19例(5.5%),Log-Rank时序检验提示,冠状动脉侧支循环不良对全因死亡有显著影响(P=0.046),而Cox回归分析提示在排除其他混杂因素后,冠状动脉侧支循环是否良好对全因死亡的影响差异无统计学意义(P=0.089)。结论对于只有一支心外膜冠状动脉急性闭塞且成功进行直接PCI发病不超过12 h的老年STEMI患者,急性期冠状动脉侧支循环是否良好对随诊12个月的全因死亡没有明显影响,但冠状动脉侧支循环良好的患者在直接PCI术后MBG为3级的比率更高,Killip心功能分级≥Ⅱ级的比率更低,说明良好的冠状动脉侧支循环仍然能对患者的预后产生一定有益的影响。Objective To investigate the eff ects of coronary collateral circulation(CCC)on all-cause mortality among elderly patients with acute ST-segment elevation myocardial infarction(STEMI)under acute total occlusion(ATO)and successful primary percutaneous coronary intervention(PCI).Methods A total of 346 elderly STEMI patients with ATO who successfully underwent PCI were retrospectively enrolled in this study.The patients were divided into two groups as poorly-developed CCC group(Rentrop grade 0-1)and well-developed CCC group(Rentrop grade 2-3)according to Rentrop classifi cation.The patients were followed up for 12 months.Logistic regression analysis was used to determine whether the poorly-developed CCC as an independent predictor of myocardial blushing grade(GMB)3,Killip grade≥Ⅱ,and using of intra-aortic ballon pump(IABP)or not.Univariate analysis(Log-Rank sequence test)was used for screening related factors for mortality,and Cox regression analysis was used to identify factors that have signifi cant impacts on mortality.Results Multivariate logistic regression analysis showed that CCC was an independent factor for predicting Killip grade≥Ⅱ(OR 0.210,95%CI 0.061 to 0.724,P=0.013),using of IABP(OR 0.272,95%CI 0.092 to 0.805,P=0.019)and postoperative MBG 3(OR 4.554,95%CI 2.148 to 9.655,P<0.001).Most of the patients were followed up for 12 months,among which,52(15.0%)patients were lost,and 19(5.5%)patients died.Log-Rank sequence test suggested that CCC had a signifi cant impact on mortality(P=0.046),however,Cox regression analysis suggested that there was no statistically signifi cant eff ect on the mortality of CCC after adjustment of other confounders(P=0.089).Conclusions For elderly STEMI patients with only one epicardial coronary artery occlusion and successfully undergoing primary PCI within 12 hours of onset,the well-/poorly-developed CCC in the acute phase has no signifi cant impact on all-cause mortality for 12 months of follow-up.However,patients with well-developed CCC have higher rates of MBG 3 after

关 键 词：急性ST段抬高型心肌梗死 冠状动脉侧支循环 老年 预后 

分 类 号：R542.2[医药卫生—心血管疾病]