冠状动脉侧支循环在急性心肌梗死的发生率、预测因素及预后研究  

Coronary collateral circulation and acute myocardial infarction:a study on incidence rate,predictive factors and prognosis

作　　者：呼日乐巴特尔 吴红丽[1] 刘雪婷 杨志鹏[1] 王洪军[1] Hu Rilebater;Wu Hongli;Liu Xueting;Yang Zhipeng;Wang Hongjun(Department of Cardiovascular Medicine,Affiliated Hospital of Inner Mongolia University for Nationalities,Tongliao 028000,China;不详)

机构地区：[1]内蒙古民族大学附属医院心血管内科,通辽028000

出　　处：《中国循证心血管医学杂志》2021年第2期236-239,245,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨急性心肌梗死(AMI)患者侧支循环发育良好的发生率、预测因素及其对预后的影响。方法研究共入选1125例成功接受经皮冠状动脉介入治疗(PCI)的AMI患者,依据Rentrop分级法分为侧支循环良好组(181例)和侧支循环较差组(944例),比较两组患者基线资料、介入相关指标与预后情况,分析影响侧支循环形成的可能因素。结果AMI患者侧支循环发育良好的比例为16.1%,侧支循环良好组患者糖尿病(23.2%vs.35.2%,P=0.002)和吸烟比例(26.5%vs.37.3%,P=0.005)显著低于侧支循环较差组,心绞痛病程显著长于侧支循环较差组(6.5±3.8 vs.4.2±2.5,P=0.024),SYNTAX评分更高(39.3±14.8 vs.32.2±12.6,P=0.039),PCI相关心肌梗死发生率更低(17.7%vs.26.7,P=0.011),其慢血流/无复流发生率更低(16.6%vs.23.8%,P=0.033)。随访1年,侧支循环良好组心力衰竭发生率(13.8%vs.22.1%,P=0.012)和总MACCE(34.3%vs.48.3%,P=0.001)显著低于侧支循环较差组。多因素回归分析显示目前吸烟(OR=1.329;95%CI:1.029~3.917,P=0.028),糖尿病(OR:2.266;95%CI:1.326~3.924,P=0.044),心绞痛病程(OR=0.769;95%CI:0.567~0.928,P=0.031),SYNTAX评分(OR=0.801;95%CI:0.608~0.937,P=0.046)是侧支循环形成的独立预测因素。结论AMI患者侧支循环发育良好者PCI相关心肌梗死和慢血流/无复流发生率更低,吸烟、糖尿病、心绞痛病程和SYNTAX评分是其独立预测因素。Objective To investigate the incidence rate,predictive factors and influence on prognosis of welldeveloped collateral circulation in patients with acute myocardial infarction(AMI).Methods AMI patients undergone successful PCI(n=1125)were chosen,and then divided,according to Rentrop classification method,into welldeveloped collateral circulation group(group A,n=181)and poor-developed collateral circulation group(group B,n=944).The baseline data,indexes related to PCI and prognosis were compared between 2 groups,and possible factors influencing collateral circulation development were analyzed.Results The percentage of well-developed collateral circulation was 16.1%in AMI patients.The percentages of diabetes(23.2%vs.35.2%,P=0.002)and smoking(26.5%vs.37.3%,P=0.005)were significantly lower in group A than those in group B.The course of angina pectoris was significantly longer(6.5±3.8 vs.4.2±2.5,P=0.024)and SYNTAX scores were higher(39.3±14.8 vs.32.2±12.6,P=0.039)in group A than those in group B.The incidence rate of myocardial infarction related to PCI was lower(17.7%vs.26.7,P=0.011)and incidence rate of slow flow/no-reflow was lower(16.6%vs.23.8%,P=0.033)in group A than those in group B.After followed up for 1 y,the incidence rates of heart failure(13.8%vs.22.1%,P=0.012)and total MACCE(34.3%vs.48.3%,P=0.001)were significantly lower in group A than those in group B.The results of multi-factor regression analysis showed that current smoking(OR=1.329;95%CI:1.029~3.917,P=0.028),diabetes(OR=2.266;95%CI:1.326~3.924,P=0.044),course of angina pectoris(OR=0.769;95%CI:0.567~0.928,P=0.031)and SYNTAX scores(OR:0.801;95%CI:0.608-0.937,P=0.046)were independent predictive factors of collateral circulation development.Conclusion The incidence rates of myocardial infarction related to PCI and slow flow/noreflow were lower in AMI patients with well-developed collateral circulation,and smoking,diabetes,course of angina pectoris and SYNTAX scores are independent predictive factors of collateral circulation development.

关 键 词：急性心肌梗死 经皮冠状动脉介入 侧支循环 预测因素 

分 类 号：R542.22[医药卫生—心血管疾病]