侧支循环对急性心肌梗死患者近期预后的影响

目的 探讨侧支循环形成对急性心肌梗死患者近期预后的影响。方法 选取行冠状动脉造影的急性心肌梗死患者130例,根据造影结果按照Rentrop分级方法将其分为侧支良好组(n=43)和侧支不良组(n=87)。对比分析两组的临床资料、左心室功能、肌酸激酶及肌酸激酶同工酶峰值浓度和临床预后等。结果 两组年龄、性别及既往史等临床资料差异无统计学意义(P>0.05),非Q波心肌梗死和梗死前心绞痛在侧支良好组较为多见,并且多支病变的发生率较侧支不良组升高;而侧支良好组左心室射血分数优于侧支不良组(P<0.01),左室舒张末期压则低于侧支不良组(P<0.01);Cortina室壁运动评分侧支良好组低于侧支不良组,差异有统计学意义(P<0.01);侧支良好组肌酸激酶和肌酸激酶同工酶峰值浓度低于侧支不良组(P<0.01);院内并发症及临床心脏事件的发生率侧支良好组优于侧支不良组。结论 急性心肌梗死前心绞痛提示侧支循环丰富,急性心肌梗死后心绞痛提示主要不良心血管事件(Mace)高。急性心肌梗死前侧支循环的形成对急性缺血心肌具有保护作用,在一定程度上减小急性心肌梗死范围,减少和预防恶性心血管事件的发生。

Impact of collateral circulation on the immediate prognosis in patients with acute myocardial infarction

Objective To investigate the impact of collateral circulation on the short-term prognosis in patients with acute myocardial infarction. Methods A total of 130 patients with acute myocardial infarction treated with coronary angiography were selected and divided into 2 groups according to the Rentrop grade:collateral circulation group (n=43) and non-collateral circulation group (n=87). The clinical data, ventricular function, CK peak, CK-MB peak and clinical outcomes were compared between the two groups. Results There were no statistical differences between two groups in patients' age, gender, and past medical history. Non Q-wave myocardial infarction and preinfarciton angina were more common, and the incidence of multivessel lesions was higher in the collateral circulation group. Collateral flow was associated with better left ventricular ejection fraction (P<0.01). LVEDP, Cortina motion score of ventricular wall, CK and CK-MB peak level were significantly lower in the collateral circulation group (all P<0.01). The incidence of nosocomial complications and clinical cardiac events of collateral circulation group were lower than those of non-collateral circulation group. Conclusion The preinfarction angina indicates rich collateral circulation, and post-infarction angina predicts higher rate of major adverse cardiovascular events. The formation of collateral circulation of preinfarction angina can protect acute ischemic myocardium, and to a certain extent, reduce infarction size of acute myocardial infarction and prevent the occurrence of adverse cardiovascular events.