急性NSTEMI与STEMI患者冠状动脉侧枝循环的发现时间及院内结局分析  

Analysis of the finding time of coronary collateral circulation and hospital outcomes in patients with acute non ST segment elevation myocardial infarction and ST segment elevation myocardial infarction

作　　者：刘江红 刘锐锋 范继红 Liu Jianghong;Liu Ruifeng;Fan Jihong(Cardiovascular Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China.;不详)

机构地区：[1]首都医科大学附属北京友谊医院心血管中心,北京100050

出　　处：《中国循证心血管医学杂志》2023年第1期45-49,60,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金(81600276);北京市临床重点专科项目经费资助。

摘　　要：目的分析不同类型急性心肌梗死患者冠状动脉(冠脉)侧枝循环的发现时间分布及院内结局情况。方法入选2013年4月至2017年4月于北京友谊医院就诊的1349例急性心肌梗死患者:ST段抬高型心肌梗死(STEMI)组患者745例,非ST段抬高型心肌梗死(NSTEMI)组患者604例,依据侧枝循环情况分为有侧枝循环组与无侧枝循环组,分析发现侧枝循环的时间分布特点,各组冠状动脉(冠脉)影像特征,以及住院期间院内结局情况。结果NSTEMI组发现侧枝循环的时间高峰有2个:第1 d和第4 d;STEMI组发现侧枝循环的时间高峰点在第6 d;NSTEMI组发现侧枝循环的比例高于STEMI组[21.52%(130/604)vs.18.66%(139/745)];NSTEMI组良好侧枝循环的比例高于STEMI组[89.23%(116/130)vs.80.58%(112/139)];代表冠脉狭窄程度的Gensini积分,NSTEMI人群有侧枝循环组高于无侧枝循环组[127.00(92.00,149.38)vs.75.00(53.00,101.63),P=0.000],STEMI人群有侧枝循环组高于无侧枝循环组[115.00(86.50,146.00)vs.82.50(61.00,109.00),P=0.000]。两组中有侧枝循环组的患者,其N末端脑钠肽前体(NT-proBNP)峰值、Killip心功能≥Ⅱ级比例、住院天数均高于无侧枝循环组患者,但心肌酶峰值及主要心血管事件(MACE)差异无统计学意义。以MACE作为结局变量进行Logistic多因素回归分析,并未发现侧枝循环的好坏是住院期间发生MACE的危险因素。结论NSTEMI人群发现侧枝循环的概率高、时间早,且良好侧枝的比例高;两组中有侧枝循环的患者,虽然其冠脉狭窄程度较重、心功能较差、住院天数延长,但是估测心肌梗死面积并不高,提示侧枝循环对心肌梗死面积有一定的保护作用。Objective To analyze the discovery time and in-hospital prognosis of coronary collateral circulation in patients with different types of acute myocardial infarction.Methods 1349 patients with acute myocardial infarction who visited Beijing Friendship Hospital from April 2013 to April 2017 were enrolled:745 patients with ST segment elevation myocardial infarction(STEMI)and 604 patients with non-STEMI(NSTEMI).They were divided into two groups according to collateral circulation:one with collateral circulation and the other without collateral circulation,Coronary artery imaging characteristics and hospital outcomes during hospitalization in each group.Results In NSTEMI group,there were two time peaks of collateral circulation:the first day and the fourth day;In STEMI group,the peak of collateral circulation was found on the 6th day;The proportion of collateral circulation in NSTEMI group was higher than that in STEMI group[21.52%(130/604),18.66%(139/745)];The proportion of good collateral circulation in NSTEMI group was higher than that in STEMI group[89.23%(116/130)vs.80.58%(112/139)];For the Gensini score representing the degree of coronary stenosis,in NSTEMI group with collateral circulation it is higher than the group without collateral circulation[127.00(92.00,149.38)vs.75.00(53.00,101.63),P=0.000],and the STEMI group with collateral circulation it is higher than the group without collateral circulation[115.00(86.50,146.00)vs.82.50(61.00,109.00),P=0.000].In the two groups,the patients with collateral circulation had higher peak value of N-terminal pro-brain natriuretic peptide(NT-proBNP),the proportion of Killip≥GradeⅡ,and the number of days in hospital than those without collateral circulation,but there was no statistical difference between the peak value of myocardial enzyme and major cardiovascular events.Logistic regression analysis of major cardiovascular events showed that collateral circulation was not a contributing factor.Conclusion The probability of finding collateral circulation in NSTEMI popula

关 键 词：急性心肌梗死 侧枝循环 时间分布 预后 

分 类 号：R542.2[医药卫生—心血管疾病]