侧枝循环对STEMI患者延期PCI术后心肌血流灌注及预后的影响  

Effects of collateral circulation on myocardial perfusion and prognosis in patients with STEMI undergoing delayed percutaneous coronary intervention

作　　者：郑佳辉 王婷婷[2] 张超 王方泽 段兴亮 王世勋[1] 王健[1] ZHENG Jiahui;WANG Tingting;ZHANG Chao;WANG Fangze;DUAN Xingliang;WANG Shixun;WANG Jian(Department of Cardiology,Weifang People's Hospital,Weifang 261041,China;Department of GeriatricsⅠ,Weifang People's Hospital;Department of Cardiology,Weifang Binhai Economic and Technological Development Zone People's Hospital,Weifang 261041,China;Department of Emergency,Weifang People's Hospital,Weifang 261041,China)

机构地区：[1]潍坊市人民医院心内二科,山东潍坊261041 [2]潍坊市人民医院老年医学一科,山东潍坊261041 [3]潍坊滨海经济技术开发区人民医院心内科 [4]潍坊市人民医院急诊科,山东潍坊261041

出　　处：《山东第二医科大学学报》2024年第6期412-416,共5页Journal of Shandong Second Medical University

基　　金：潍坊市科技发展计划项目(医学类)(项目编号:2021YX101)。

摘　　要：目的分析侧枝循环对ST段抬高型心肌梗死(STEMI)患者延期PCI术后心肌血流灌注及预后的影响。方法选取146例接受延期PCI治疗成功且梗死相关动脉TIMI血流0级或1级的STEMI患者为研究对象。根据Rentrop分级将患者分为侧枝循环不良组(Rentrop分级为0,1)和侧枝循环良好组(Rentrop分级为2,3)。记录两组患者的基线资料及PCI治疗的影像资料,比较两组患者术后即刻TIMI血流分级、校正的TIMI血流帧数,无复流以及慢血流发生率。随访时间不少于12个月,主要终点为死亡,次要终点为主要不良心血管事件(MACE),包括心源性死亡、非致死性心肌梗死,因心力衰竭再入院。结果侧枝循环良好组患者PCI术后即刻TIMI血流3级的比例较侧枝循环不良组高,差异有统计学意义(P<0.001);侧枝循环良好组患者无复流及慢血流的发生率较侧枝循环不良组低,差异有统计学意义(P<0.001);侧枝循环良好组患者PCI术后即刻CTFC较侧枝循环不良组少,差异有统计学意义(P<0.001)。两组患者的生存率、MACE事件的发生率差异无统计学意义;将性别、年龄、吸烟、既往病史(糖尿病、高血压、血脂异常、脑血管病、既往心绞痛)、eGFR、BNP、Killip分级、梗死部位、单支冠脉病变、发病到PCI时间等因素纳入多因素COX回归分析,侧枝循环与患者的生存率(HR,1.049;95%CI:0.138-7.971;P=0.963)及MACE事件的发生率(HR,0.822;95%CI:0.265-2.552;P=0.734)无显著相关。结论在接受延期PCI治疗的STEMI患者中,侧枝循环形成良好的患者PCI术后心肌血流灌注水平更好,无复流及慢血流发生率更低;侧枝循环与患者的生存率、MACE事件的发生率无显著相关。Objective To explore the effects of collateral circulation on myocardial perfusion and prognosis in patients with STEMI undergoing delayed percutaneous coronary intervention.Methods One hundred and forty-six STEMI patients treated with successful delayed percutaneous coronary intervention and TIMI flow grade of infarct related artery≤1 participated in research.Patients were categorized according to Rentrop grade to 2 groups:poor collateral circulation group(Rentrop grade 0,1)and good collateral circulation group(Rentrop grade 2,3).Baseline and angiographic characteristics of two groups were recorded.TIMI flow grade and corrected TIMI flame count after PCI,incidence of no reflow or coronary slow flow were analyzed between two groups.Follow-up time was no less than 12 months.The primary endpoint was death,the secondary endpoint was major adverse cardiovascular events(MACE),including cardiac death,nonfatal myocardial infarction and readmission due to heart failure.Results The proportion of TIMI blood flow grade 3 after PCI in good collateral circulation group was higher than that in poor collateral circulation group(P<0.001).The incidence of no reflow and coronary slow flow in good collateral circulation group was lower than that in poor collateral circulation group(P<0.001).The CTFC after PCI in good collateral circulation group was less than that in poor collateral circulation group(P<0.001).There was no significant difference in survival rate and incidence of MACE between the two groups.Factors such as sex,age,smoking,previous illness history(diabetes,hypertension,dyslipidemia,cerebrovascular disease,previous angina pectoris),eGFR,BNP,Killip grade,infarct site,single-vessel coronary disease,and time from onset to PCI were included in multivariate COX regression analysis,there was no significant correlation between collateral circulation and survival rate(HR,1.049;95%CI:0.138-7.971;P=0.963)and incidence of MACE(HR,0.822;95%CI:0.265-2.552;P=0.734).Conclusions Among patients with STEMI receiving delayed PCI,those

关 键 词：侧枝循环 ST段抬高型心肌梗死 经皮冠状动脉介入治疗 心肌血流灌注 预后 

分 类 号：R542.22[医药卫生—心血管疾病]