心肌梗死时冠状动脉侧支循环的临床意义及促发因素  

Potential Precipitating Factors and Clinical Significance of Coronary Collateral Circulation in Patients with Acute Myocardial Infarction

作　　者：刘锐锋 梁思文[1] 高翔宇[1] 赵慧强[1] LIU Ruifeng;LIANG Siwen;GAO Xiangyu(Department of Cardiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院心脏病科,100050

出　　处：《医学研究杂志》2022年第7期41-46,共6页Journal of Medical Research

基　　金：国家自然科学基金青年科学基金资助项目(81600276);北京市首都健康保障培育项目(Z181100001618001)。

摘　　要：目的 探讨急性心肌梗死(acute myocardial infarction,AMI)患者冠状动脉侧支循环(coronary collateral circulation,CCC)形成的潜在促发因素和临床意义。方法 从2712例AMI患者中入选的1662例符合研究条件的患者分为CCC组和非CCC组。分析两组的基本临床特征和冠状动脉造影数据,利用Logistic回归分析探讨影响CCC形成的潜在因素,以及比较住院期间心脏功能、估计梗死面积大小和主要心血管事件(main cardiovascular event,MACE)。结果 两组之间基线资料总体均衡,CCC组冠心病病史(既往诊断)和陈旧性心肌梗死病史高于非CCC组。冠脉状动造影结果提示,CCC组冠状动脉狭窄程度较大,各支血管存在狭窄的比例较高。Logistic分析显示,CCC的促发因素包括:年龄、冠心病病史、陈旧性心肌梗死病史、冠状动脉狭窄程度。临床结局方面,CCC组住院日较长,心功能较差,但心肌梗死面积并不比非CCC组大,两组之间MACE事件无显著差异。结论 伴随有CCC的AMI患者,存在冠心病病史和陈旧性心肌梗死病史的比例较高,其冠状动脉狭窄程度较高;年龄、冠心病病史、陈旧性心肌梗死病史、冠状动脉狭窄程度等是CCC形成的促发因素;CCC不能有效改善住院期间的心功能和减少住院日,但伴随有CCC的AMI患者,其心肌梗死面积和MACE事件不高于无CCC的AMI患者,提示CCC有不全面的保护作用。Objective To explore the potential precipitating factors and clinical significance of coronary collateral circulation(CCC) formation in patients with acute myocardial infarction(AMI).Methods 1662 patients eligible for the study were selected from 2712 AMI patients,and then divided into CCC group and non-CCC group.By analyzing the basic clinical characteristics and coronary angiographic data of the two groups.The potential factors affecting the formation of CCC was explored using Logistic regression,and cardiac function during hospitalization,estimated size of infarction and major cardiovascular events(MACE) were compared.Results The baseline information between the two groups was generally balanced.The history of coronary artery disease(CAD) and old myocardial infarction in the CCC group were higher than that of the non-CCC group.The results of coronary angiography suggested that the degree of coronary stenosis in the CCC group is greater.Logistic analysis showed that the precipitating factors of CCC included age,history of CAD,history of old myocardial infarction,degree of coronary artery stenosis.In terms of clinical outcome,the CCC group had poorer cardiac function and longer hospitalization days,but the area of myocardial infarction was not larger than that of the non-CCC group.There was no significant differences in MACE events between the two groups.Conclusion AMI patients with CCC had higher degree of coronary artery stenosis.Age,history of CAD,history of old myocardial infarction and degree of coronary artery stenosis are the promoting factors of CCC formation.CCC can not effectively reduce hospitalization days and improve cardiac function during hospitalization,but the myocardial infarction area and MACE of AMI patients with CCC are not higher than those without CCC,suggesting that CCC has an incomplete protective effect.

关 键 词：冠状动脉侧支循环 急性心肌梗死 心脏功能 梗死面积 

分 类 号：R5[医药卫生—内科学]